OP RHTE# a8-~ a~~? ~k- Harnett County Department of Public Health 21 2 8 7
PERMIT # °Z~~ y~ Operation f ermit
? New Installation C>~Septic Tank ❑ Repair L~Nitrification Line ❑ Expansion
PROPERTY LO(ATION: s : ~n L : ~ _
Name: (owner) CZ1" ~ o,ti er SUBDIVISION ~aQ-~s~ T~ (f LOT # /f C
System Installer: ln} Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community C1~Public ❑ Well Distance from well feet
System Type: 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.
ims system nas 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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PERMIT CONDITION(•
I. Performance: System shall perform in accordance with Rule .1961. ln+ati
II. 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:
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V. Other: 1,e4n~ x . 4 P..~r c~ . ~ ~ Oe rn lam.
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Following are the specifications for the sew_,3p disposal s stem on t e ab a ca honed Pf'operty
Type of system: ❑ Conventional Other ~y t C irk. Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 500 feet ditches -3 feet ditches _ inches
French Drain Required: Linear feet
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