OP - for tank replacementHTE# 0~ 5 tic V0 S0 Harnett County Department of Public Health
PERMIT # 6 I Operation Permit
20698
❑ New Installation O? Septic Tank ❑ Repair ❑ Nitrification Line ❑ Expansion
PROPERTY LOCATION: e-,,,
Name: (owner) <.wy 4/. SUBDIVISION LOT #
System Installer: ARegistration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑FCommunity ❑ Public ell Distance from well feet
System Type: ji Types V and VI Systems expire in 5 years.
(In accordance with Table fa)-
a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ims system nas oeen mstaneo in
f)C~111T fA11f11T1A 11f
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
1. Performance:
11. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. 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: El Conventional El Other -f,/$ NP Septic Tank: ~0 gallons Pump Tank: I gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent.-''_!f;~ ~ ~ Date I) 6 g / 6