OP RHTE# 0- Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 2 5 0
New Installation V Septic Tank ~4 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Kc,D o uc-P Lz QD
Name: (owner) SUBDIVISION W i,_L S n5 LOT #
System Installer: R-, crQ.,Z4 x oytat,,~,9 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t Q e 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.
ims system has Deen mstanea in compliance with appucame North taronna uenerai statutes, naves for sewage treatment ana msposai, ana an contuttons of the improvement rennut and Lonstruction Authorization.
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PERMIT CONDITIONS:
1. 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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captio d property.
Type of system: ❑ Conventional X Other E, Rm C~") Septic Tank: E4~ d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch O feet ditches 3 feet ditches » inches
French Drain Required: ®Linear feet
Authorized State Agent Date 4N "At
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