OP RHTE# Cis-Sj@,JQ, Harnett County Department of Public Health 21118
PERMIT #Operation Permit
New Installation X Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LKATION:_ LE-~V6L. 6~pcsc_(Z~
Name: (owner) SUBDIVISION oaf-- O>Y-s LOT # 1
System Installer. C>T, -;If Registration #
Basement with plumbing: ❑ Garage Ji~ Number of Bedrooms __Ll
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well too feet
System Type: .SiI Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
finis 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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PERMIT CONDITIONS:
I. Performance:
If. 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 Other E2- Septic Tank: 10 00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch Igo feet ditches feet ditches . IR-aq _ inches
French Drain Reauired-
Authorized State Agent Date 48
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