OP RHTE# g)-5-N164o2 Harnett County Department of Public Health 25077
PERMIT # �.°►« Operation Permit
XNew Installation Septic Tank Ification Line El Repair ElExpansior
PROPERTY LOCATION: r)&W tLL%
Name: (owner) SUBDIVISION LOT # 3G
System Installer:-nr6et�—1 SHrwaWry Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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 on been installed in Compliance with applicable North Carolina General stamtes, Rules for Sewage Treatment and Dispoml, and all conditions of the Improvement Permit and Construction Authorization
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Np�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLme ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'X Other 112E \P `J Septic Tank: 10 0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch 1000 feet ditches ��
g � feet ditches inches
French Drain Required: Linear feet
Authorized State Agents , \\ �+��5 Date
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