OPHTE# i ybil Harnett County Department of Public Health 19908
PERMIT Operation Permit
~ew Installation IS-3eptic Tank ❑ Repair 07 Nitrification Line ❑ Expansion
PROPERTY LOCATION: n C -7
Name: (owner) SUBDIVISION (1 ni e Z LOT #
System Installer. C- X - t S ~t Registration #
Basement with plumbing-, ❑ Garage ❑ Number of Bedrooms
Type of Water S~P ly: ❑ Community IK Public ❑ Well Distance from well feet
System Type: y -'L f ~ Q J1' 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.
tors em nas Deer msWW in com ' e with 'c*k North Carolina &fwal Statutes, W for kwap Treao mt and Disposal, and A co &wm of the kn ent Permit and Consnssmon Atrdtoriuaw
7a
s A
T
PERMIT CONDITIONS:
I. Performance:
II. 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 se a disposal s tem on a above captioned property.
Type of system: ❑ Conventional Other - ~ 0 \1 Size of tank: Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State
Date D/-,,?91 - r