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71L Harnett County Department of Public Health 21 3 0 3
PERMIT # Operation Permit
New Installation [9- Septic Tank ❑ Repair nitrification line ❑ Expansion
PROPERTY LOCATIO : e k- re.~.
Name: (owner) Co ty4n" J:.' SUBDIVISION _ ~~`~~c~~- -LOT # /2,
System Installer: v Ste{ Registration #
Basement with plumbing: ❑ Garage ❑ L public of Bedrooms
Type of Water Supply: ❑ Community L~ Public ❑ Well Distance from well feet
System Type: T1~ 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.
This 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.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:,
IV. Operation:
V. Other:
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VS
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting
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Following are the specifications for the sewa dispos system on the above captioned oper
Type of system: ❑ Conventional Ltd" Other x'1_10 4i, G'. ~ (3 Septic Tank: Oao gallons Pump Tank: l00 Q allons
Subsurface No, of exact length width of g
Drainage Field ditches depth of
of each ditcho~ l feet ditches feet ditches' ` inches
French Drain Required: I;,,,
Authorized State Agent_ c -GW 1) 4~ No
Date
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