OP RHTE# ns- sue- Harnett County Department of Public Health 2 0 7 4 9
PERMIT # S~ Operation Permit
New Installation '~k Septic Tank F~ Repair Nitrification Line D Expansion
PROPERTY LOCATION: 2 S~
Name: (owner) SUBDIVISION -rOA OA K LOT # 12S~
System Installer: C Ct~Ar Registration #
Basement with plumbing: ❑ Garage 4 Number of Bedrooms
Type of Water SuppI : ❑ Community 'K Public ❑ Well Distance from well 1,O-,7) feet
System Type: "A - c K 11-{ 1g$ Cr' 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 Sevrage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1 Ll11111 l.Vl\UII IV I\J.
1. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule 1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No t~r
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal tem on the above captioned property.
Type of system: ❑ Conventional Other ~.A'N t y Septic Tank: 12v gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date '
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