OPH T E # 0`3 Harnett County Department of Public Health 21 1 4 9
PERMIT # Operation Permit
CNew Installation 2~ Septlc Tank ❑ Repair P'-Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1cr Z 1,
Name: (owner) SUBDIVISION LOT # /Q
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: .;:Ti 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.
This 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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111/1111 WIND 11Vi1J.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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:
Following are the specifications for the sew ge dispos system on the above ca tinned property.
Type of system: ❑ Conventional Other ter-kA ~a '.'J Septic Tank: GsgG gallons Pump Tank: gallons
Subsurface No. of exact Iength width of depth of
Drainage Field ditches of each ditch /6-0 feet ditches feet ditches inches
French Drain Required: Linear feet
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