OP RHTE# J � " 5 - Q, Harnett County Department of Public Health 23134
PERMIT # `� �L1 Operation Permit
New Installation Septic Tank ' < Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: X154 VD
Name: (owner) SUBDIVISION 'L— z, FNLe, U_ r-, LOT # _I
System Installer: 7 ego ia)aa.o ra Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 5b feet
System Type: 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 instaueo in compliance with applicable north larolina heneral Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the
YtKMII t.UNUIIIUNJ:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Permit and construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the above caption roperty.
Type of system: ❑ Conventional Other �r1Pim3 tz_ CQ�, Septic Tank: I tO0 gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch 6 4 feet ditches feet ditches
French Drain Reauired: " -� Lineal" feet
Authorized State Agent Date
PWR Line
gallons
inches
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