OP RRRHTE# o7-~s = 1xk Harnett County Department of Public Health 21 14 3
PERMIT # . 2 0 eration Permit
New Installation Septic Tank ❑ Repair C"Nitrification Line ❑ Expansion
PROPERTY LOCATION: o.r ilb X'-P.
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Name: (owner) Se
el- SUBDIVISION ~,,4 LOT # / V0
System Installer: Registration #
Basement with plumbing ❑ Garage Zumber of Bedrooms
Type of Water Supply: ❑ Commublic El Well Distance from well feet
System Type: uni L P Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ums system nas Deen mstaneo in compliance with applicable North tarohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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DCDMIT rAil r11T1A\IC.
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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Following are the specifications for the seeww9rdispos }system o~j the a ve captioned ~Co~rty.
Type of system: ❑ Conventional Lrl Other Q ax 'Td i~ ~1 h4 ~ Septic Tank: ~ a gallons Pump Tank: /030 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches f of each ditch feet ditches 3 feet ditches / ~9 -lT inches
french Drain Required: Linear feet
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Authorized State Agent Date 1Z/a 2cra 9