OPHTE# a'1 -s-aa~ tea, Harnett County Department of Public Health 21224
PERMIT # Operation Permit
New Installation Septic Tank El Repai~V Nitrification Line ❑ Expansion
PROPERTY LOCATION:CdG`L C,
Name: (owner) SUBDIVISION LOT #
System Installer: 0 e Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I cbd feet
System Type: STIR 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.
nus system nas oeen msianeh in
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with appucaole north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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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 sewage disposal system on the above captioned property.
Type of system: `";Qonventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch I O~ feet
French Drain Reauired: ''Itiuaar foAt-
Septic Tank: IboO gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
Authorized State Agent p Date
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