OP RHTE# J7 ~'b-- 4-1x3 k Harnett County Department of Public Health 19676
PERMIT # Operation Permit
L New Installation E?- Septic Tank ❑ Repair Z,2 Nitrification Line ❑ Expansion
PROPERTY LOfATION: 12 N :
Name: (owner) ^^1~« SUBDIVISION LOT # Z_
System Installer. Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms -,:3-
Type of Water Supply: ❑ Community P Public ❑ Well Distance from well ~J feet
System Type: ' ~ s I V-f-s _ c, c tic t-k TA-3- Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ttus system has peers nstaw in compiance with appic" xortfs (rohru General Statutes, Ades for Sew Treumem atd DiTvA and aA conhtiom of the tan emmt Perstat and (onmuctims Audw aatiwa
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PERMIT CONWTION~-
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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 see disposal Tystem on ate above captioned property.
Type of system: ❑ Conventional Other l\- `t Size of tank: Septic Tank: J t7 gallons Pump Tank: gallons
Subsurface No. of exact length ~J width of depth of
Drainage field ditches of each ditch feet ditches feet ditches__ _ inches
French Drain Required: Linear feet
Authorized State
Date _ d 3