OPATE #_� L4 —5�33 0_�,S_ Harnett County Department of Public Health J
PERMIT # Operation Permit
New Installation >' Septic Tank ' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:-7, t��_� c7w��t;�® c2..
Name: (owner) SUBDIVISION JOT # '121
System Installer: 16:e e � c- Registration #
Basement with plumbing: ❑ Garage IX Number of Bedrooms
Type of Water Supply: ❑ Community 'V Public ❑ Well Distance from well 100 feet
System Type: 1 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.
Im system has been Installed in compliance with applicable North larohna beneral )tatutes, Rules for )ewage Treatment and Disposal, and all conditions of the
10C)
n�
�1
T)a..0 NOwjN(ijI/M
PERMIT CONDITIONS:
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 ❑ N0
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Permit and Lonstruction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposalsystem on the above captioned property.
Type of system: F-1 Conventional Other G.Fi-u c Septic Tank: 1 4 ®0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field . es of each ditch 1 ®� feet ditches feet ditches N inches
French Drain Reauired: feet
Authorized State Agent ,� 1�� °� Date '