OP RRHTE# o Up- a,~ 133 Harnett County Department of Public Health 2 0 9 2 2
PERMIT # Operation Permit
tjZ_ New Installation Septic Tank ❑ Repait,.,Z Nitrification Line ❑ Expansion
/ PROPERTY LOCATION: 'I S'
Name: (owner) 0 SUBDIVISION L_~~ 1, LOT
System Installer: t7S f C !J-~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Suly: El Community Public 1:1 Well Distance from well JO feet
System Type: L • 2 r_71 0\_j :j ~ Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ~rl ther - IF (l_~'j Septic Tank: c~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of r
Drainage Field ditches of each ditch ~S~V_ feet ditches . 5 feet ditches D `t inches
French Drain Required: linear feet
Authorized State Agent. Date
Itus system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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