OP RHTE# /Y-,5 1/2 -;re Harnett County Department of Public Health 23432
PERMIT # -2- a 0130 Operation Permit
[a New Installation C;KSeptic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
/1-10- �4s//a,.j,,`.ed
Name: (owner) I (-i-a� /t'1 `llav SUBDIVISION LOT #
System Installer: J -4' y 4e Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -2,
Type of Water Supply: ❑ Community C7' Public ❑ Well Distance from well feet
System Type: ;gz::a 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.
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 additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewa disposal system oq the above captioned property.
Type of system: El Conventional 7Other%�lh of Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet /
Authorized State Agent �T Date f2 /!2 /Z 00/