OP RHTE# O7 -5-1053f, Harnett County Department of Public Health 21 4 5 4
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 0 WELL ~ws SUBDIVISION Go+T6wLOT # OLZE
System Installer Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well S Oo feet
System Type: ~~c, 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 peen mstanea in compliance with applicable North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other CZ Septic Tank: 14!!)0 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches I~ inches
French Drain Reouired: z~, " ~Str frel
Authorized State Agent o vV ~,A tLCNu Date 51 :),,31110