OP RH T E # 001-Harnett County Department of Public Health 2 0 8 2 0
PERMIT #Operation Permit
] New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: "w-lP`rJ
Name: (owner) P,c~~c,R~ ~10~.,1✓sct~~~~ SUBDIVISION 1901„'% LOT #2n
System Installer. R~~-~~► ~d~-~aNa Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1O~ feet
System Type: ~S 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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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other:
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Following are th
e specifications for the sewage disposal system on the above captioned property.
Type of system:
E Z Fw
El Conventional Other '70
Septic Tank: 000
gallons Pump Tank: 1006 gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditches 1 of each ditch 1 ' o feet
ditches 3
feet ditches inches
french Drain Required: Linear feet
Authorized State Agent 3 Date --iii
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