OP RNTE#1 / 7S 3y 71Z Harnett County Department of Public Health 23519
PERMIT # Z Q 7 ! Operation Permit �
C�New Installation Ea Septic Tank C" Nitrification line ❑ Repair ❑ Expansior
PROPERTY LOCATION: -/y3 7
Name: (owner) G � A,, �� SUBDIVISION �i3.�u�� l� LOT
System Installer: ��' Ny!,Q Registration #
Basement with plumbing: ❑ Garage Vpublic
umber of Bedrooms -3
Type of Water Supply: El Community ❑ Well Distance from well feet
System Type: 7 Types V and VI Systems expire in 5 years.
(In accordance with table V a) Owner must . act 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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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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewagpldisposal system on the above captioned, property.
Type of system: El ER/Other �,Q a c{ Septic Tank: % 0 y C gallons Pump Tank: / y gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch CSO feet ditches ✓ feet ditches Zy
T inches
French Drain Required: Linear feet
Authorized State Agit Date