OP RRRHTE#07- ~5- 11.YS'`7fex- Harnett County Department of Public Health 21 1 5 9
PERMIT # Operation Permit
New Installation Z Septic Tank ❑ Repair Cis Nitrification Line ❑ Expansion
PROPERTY LOCATION:A'i rsc~~,C4
Name: (owner) C(r.4,itif "acv c%r SUBDIVISION Wool i-4; re. LOT # i 6.7
System Installer: -3:>, : C Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 1?"Public ❑ Well Distance from well feet
System Type: 7jr C- 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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PERMIT CONDITIONS:
reriormance: Nystem shall pertorm in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
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 disposal stem on the above captioned property.
Type of system: ❑ Conventional 91 Other fit. C Ilk~w•.(v~' Septic Tank: a a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches. feet ditches' inches !l r
French Drain Required: Linear feet4-~( 0A,
Authorized State Aged
Date
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