OPt Harnett County Department of Public Health ,
PERMIT #'� Operation Permit
New Installation' l Septic Tank', Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N1 --V IWG- a.--
Name: (owner) SJ U ;,��� -�-`� SUBDIVISION �Na�r�� L�i'��C�Symm LOT #
System Installer: ���. Q�-��S— Registration #
Basement with plumbing: ❑ GarageX Number of Bedrooms
Type of Water Supply: ❑ Community ' Public ❑ Well Distance from well V b Q feet
System Type: ti G, 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.
PERMIT CONDITIONS:
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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the gewage disposal system on the above c tionekroperty.
Type of system: ❑ Conventional Other QV'NtsgNS � �+x Septic Tank: t gallons Pump Tank: gallons
Subsurface No of exact length width of depth of
Drainage Field ditches of each ditch feet ditches _� feet ditches 30-A inches
French Drain Reauir igear feet
Authorized State Agent , � ��� \� %"!, Date 40 R