OP RHTE#-LA?- ~',-nHarnett County Department of Public Health 20571
PERMIT Operation Permit
"E"w Installation~ptic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOC IAT ON:~ jtl a
Name: (owner) C\ SUBDIVISION LOT # 31
System Installer: Registration #
Basement with plumbing: ❑ Garage 4-Number of Bedrooms
Type of Water Supply: ❑ Community J0 Public ❑ Well Distance from well ~OJ feet
System Type: F_ 2 - Types V and VI Systems expire in S 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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PERMIT CONDITION(-
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation
IV. Operation:
U vL- PC
maintenance and reporting.
V. Other. ~D- t ~ t
Following are the specifications for the sewage disposal sy tem on the above captioned property.
Type of system: ❑ Conventional Other, `r!, J Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch (J feet ditches - feet ditches t ~LL inches
French Drain Required: Linear feet
Authorized State Agent L- - Date L-) `z 1
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