OP RHTE# - 1'19Y Harnett County Department of Public Health
PERMIT Operation Permit 21 8 3 3
Ob~~~ }r 1 New Installation Septic Tank Nitrification Line El Repair El Expansion
'V-S PROPERTY LOCATION:
Name: (owner) SUBDIVISION LOT #
System Installer: i 15- 5`ti'Q-\ 4--"-N-%_2 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t t`? feet
System Type: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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules far Sewage Ireatment and msposal, ana an conamons or the Improvement rermic am] consrruction numonzanon.
~~P,}>St'sGf JX F- W,\F-
PERMIT CONDITIONS:
1. 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
If yes, see attached sheet for additional operation a
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201.ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: p Conventional Other C- ~ ~7 L0 'v ,,t Septic Tank: \~'-10 17) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ' of each ditches feet ditches feet ditches inches
French Drain Required:"~- =-U r tE~t,
Authorized State Agent _ ~ ~ (-)I"- Date JE
a k,6" -s= t r? Y/