OP RH T E # 1-,5-- Za-Za'~ A Harnett County Department of Public Health 21 3 01
PERMIT # Operation Permit
k/New Installation IP Septic Tank ❑ Repair 1?' ~ Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~r=4
Name: (owner) k- ti r LA- SUBDIVISION ~fa~~ LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage e ?'-Number of Bedrooms ,3
Type of Water Supply: ❑ Community ~ublic ❑ Well Distance from well feet
System Type: 177'- 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.
ms system has 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 rrimnlTMAK
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 additil operation Conditions, ma_int nance and reporting.
IV. Operation: l pct f IW,-0 Q
V. Other: t o Ce- r ~-t
Following are the specifications for the sewwi dispos stem on~,th eaove c Honed p~Op erty.
Type of system: El Conventional L~ Other _ y , Cdr ' (3 hh Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch o2 feet ditches feet ditches inches 01,"k fc"
French Drain Required: Linear feet S~ r
Authorized State Agent Date 112,
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