OP RH T E # /0 -3 .Zs--r° Harnett County Department of Public Health
PERMIT # Ic?(, Operation Permit 21 81 8
❑ New Installation Li7'~Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: GI z✓
Name: (owner) j 7k? V L ~;>M SUBDIVISION LOT #
System Installer: 4 ,e.-v Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Ele'Public ❑ Well Distance from well feet
System Type: e Zr 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.
1111] SpWm uaS Veen MONO in compuance wim applicable North Carolina General Statutes, Rules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
PERMIT rONnITIONS-
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No P"
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of / exact length
Drainage Field ditches of each ditch feet
French Drain Required: Linear feet
Alarm ❑
H2OLine ❑
Septic Tank: 0V gallons Pump Tank:
width of depth of
ditches feet ditches
PWR Line
gallons
inches
Authorized State Agen /1f Date