OP RRHTE# '00-1 i3 D f R2 Harnett County Department of Public Health 2 0 7 3 6
PERMIT # 5~1 Operation Permit
New Installation tlc Tank ❑ RepairO~. 'trification line ❑ Expansion
PROPERTY LOCATION: Z
Name: (owner) {c crnef~ C~r,~.n „112 SUBDIVISION /7) c LOT # -2,Z)Y
System Installer: . ~2r ck Registration #
Basement with plumbing: ❑ Garage - Number of Bedrooms r
Type of Water Sup IY: ❑ Community Public ❑ Well Distance from well feet
System Type: -'Z F 1-3, l_..1 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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PERMIT CONDITIONS: ~,~f
1. Performance: System shall perform in accordance with Mule .1961. U -
If. 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 sy m on the above captioned property.
Type of system: ❑ Conventional Other 2 ~ - ~ Septic Tank: J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 0( feet ditches feet ditches inches
French Drain Required: Linear feet
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Authorized State Agent__ - Date
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