OP RATE# Harnett Department Public Health
s
PERMIT # `,mil Operation Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) �A o z�� r _2 SUBDIVISION LOT # 1 i
System Installer: 1c� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms :
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: o, 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.
ims system nas been mstaheo in compliance with applicable North Larolma beneral Statutes, Kules for Sewage treatment and Disposal, and all conditions of the
yJ J)? 4)`f)06 0 �y
Permit and Construction Authorization.
YtKNII LUNUIIIUNJ:
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abov captiotie� property.
Type of system: El
Conventional X Other �`� °s,r�aS7i C� `j Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of exact length width of
depth of
Drainage Field
ditches Beach ditch lG feet ditches
feet ditches inches
French Drain Reauired:
dear feet'`\
Authorized State Agent `� Date 01L_11
1-3 - 5-3 � 1 �L