OP RHTE# O1"~00' tYJ3 1.lL Harnett County Department of Public Health 19673
PERMIT # Operation Permit
-LA New Installation P~--Septic Tank ❑ Repair fl Nitrification Line ❑ Expansion
PROPERTY LOUITION: N a1
Name: (owner) SUBDIVISION LOT
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply Q Community Public ❑ Well Distance from well feet
System Type: ` t) t tt 4 V / Types V and VI Systems expire in 5 years.
(In accordance with Table V al Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ttas system has ban iostaped in
with appmcable North Carolina General
Ames for Sewage Treatment and Disposal, and aN condinomn of the Improvement Pemdt and Construction Authontaum
V
73'
PERMIT CONM3fT1.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
117
System shall perform in accordance with Rule .1961. 4~ clan t
As required by Rule .1961. i c
As required by Rule .1961. Other. 'j-
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑ Conventional Other Size of tank: Se tic Tank: b') J
Subsurface No. of p gallons Pump Tank: gallons
exact length 1 , width of depth of
Drainage field ditches of each ditch S1 J feet ditches- feet ditches- inches
french Drain Required: linear feet
Authorized State Agent Date .-1 ~ ) l~