OP RHTE#(2Y goo-~ 3-712 Harnett County Department of Public Health 20581
PERMIT t,311 _ eration Permit
New Installation Septic Tank ❑ Repai6 Nitrification Line ❑ Expansion
L-\,Nk ROPERTY I Name: (owner) n~~~ P SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Sup : El Community Public El Well Distance from well jypes feet
System Type: ' ( 1~ -M V and VI Systems expire in S years.
(In accordance with Table V a) 0 er must contact Health Department 6 months prior to expiration for permit renewal.
Ihis 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 Author6tion.
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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No iA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the specifications for the sewage disposal m on the above captioned property.
Type of system: ❑ ConventionalQther ~ (t Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth ofi
Drainage field ditches of each ditch- feet ditches feet ditrhas 1~;~ inrhnc
rent rain Required: linear feet
Authoriz=State t Date Q
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