OP RRHTE# Harnett County Department of Public Health 2 0 5 0 3
PERMIT # Q5 0 VS Operation Permit
'New Installation 2~7"Se tic Tank ❑ Repair K Nitrification Line ❑ Expansion
PROPERTY LOCATION: 2
Name: (owner) SUBDIVISION 7 c) A k LOT #
System Installer: C l,-~ C(-- Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms
Type of Water S ply: ❑ Community 5CPublic ❑ Well Distance from well \ 213 feet
System Type: U : I, C \ .-_-[a TV6 Types V and VI Systems expire in S years.
(In accordance with Table 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:
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 conditions, maintenance and reporting
Following are the specifications for the sF'Other isposals em on the above captioned property.
Type of system: ❑ Conventional Ok Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches _ feet ditches Z inches
French Drain Required: Linear feet
Authorized State Agent Date
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