OP RHTEOt-5r 36R, Harnett County Department of Public Health 2 0 5 2 2
PERMIT # as~~ Operation Permit
New Installation >;4 Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: ^["Q-QELovfs~~Q~~Sc~.
Name: (owner) 5-crn L--_z \ko M6< SUBDIVISION LOT # ~4
System Installer: 9__gV4oy liiwnEA Registration #
Basement with plumbing: ❑ Garage N Number of Bedrooms '
Type of Water Supply: ❑ Community Public ❑ Well Distance from well iO4 feet
System Type: ~11't 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 for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: IMQ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field - of each ditch aa~ feet ditches 3 feet ditches 14 inches
French Drain Required: inear feet
Authorized State Agent >r Date
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