OPFITE# Harnett County Department of Public Health 21 31 8
PERMIT # Operation -Permitit
"ew Installation R Se tic Tank ❑ Repair nitrification Line ❑ Expansion
PROPERTY LOCATION: r l2~
Name: (owner) SUBDIVISION Cf- ~v LOT # 16. A
System Installer rryA2.roe Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 0,
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well 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.
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.
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DrOMIT rnunrT!n tic.
1. 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 additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the specifications for the seewwa e posal system on the bove captioned property.
Type of system: ❑ Conventional 0( Other I' "'re- U• Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 1Z of each ditch JO feet ditches 2 feet ditches inches
French Drain Required: Linear feet
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