OP RHTE A4 c�'IQ Harnett County Department of blic Health 23311
PERMIT # r 3� -i Operation Permit
J New Installation-�Q Septic Tank Nitrification Line F-1 Repair I—] Expansion
�°- PROPERTY LOCATION:Gs�(,
Name: (owner) U SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community '�14 Public ❑ Well Distance from well Vt(3 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
ERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dispostaLsystem on the above ca tione roperty.
Type of system: El Conventional Other �� �-�� AMS6(L � � ' Septic Tank: 100 ?i gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field 4itdes of each ditch feet ditches 3 feet ditches inches
French Drain ReauireK--*!. -__ .Linear feet
Authorized State Agent �,., ®_l _ Date