OP RHTE# Q' ►l Harnett County Department of Public Health 21259
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: S9-11 i1 t- vQQG
Name: (owner) SUBDIVISION VloovsH~Q~L LOT #
System Installer. . C_ . cp"': (L Registration #
Basement with plumbing: ❑ Garagej Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~ O 0 feet
System Type: -LU 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 (arolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. 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 x
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: ttevt~ C~osFS~~~ ~~w~v QnoPL,H 5`-~Hli&N ~Pn1,.sR6o PnePo3A S~at*stfiED moo U
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following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1 )a~G G-NNP5 Septic Tank: khQ~0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches `f each ditch 75 feet ditches feet ditches inches
French Drain Required: _ Tnn
Authorized State Agent a~5 Date
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