OP RHTE#O°t-5-St2 Harnett County Department of Public Health 21 3 4 9
PERMIT # ass 7 O Operation Permit
New Installation X Septic Tank ❑ Repair"X Nitrification Line ❑ Expansion
PROPERTY LOCATION: Me
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Name: (owner) ~f C" I SUBDIVISION LOT #
System Installer: ~ E9 Fxz ov, Registration #
Basement with plumbing: ❑ Garage ` Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: =)p 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 fonswction Authorization.
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PERMIT CONDITIONS:
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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
following are the specifications for the sewage disposal system on the above captioned property
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Type of system: ❑ Conventional Other Septic Tank: ibob gallons Pump Tank: jocc) allons
Subsurface No. of exact length width of g
Drainage Field ditches depth of
of each ditch :i,Q t-1 feet ditches 3 feet ditches 14 inches
French Drain Required: inear fe how NaSve
Authorized State Agent__ ~r Eli Date 3) z'►
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