OP RHTE#_S_W ~`M~~ Harnett County Department of Public Health 2 0 7 6 3
PERMIT # Operation Permit
CPI: New Installatio /r e"ptic Tank ❑ Repa~- Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) (~21A SUBDIVISION VD, #
System Installer: nA-_ Registration #
Basement with plumbing: ❑ Garagepg.*mber of Bedrooms
Type of Water Supply: Community 1Z Public ❑ Well Distance from well y feet ~w
System Type: < < Types V and VI Systems expire in S years. -fd-
(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 Authonzati..' I
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PERMIT CONDITIONS: (Vt ~1 ~
1. Performance: System shall per(6ri in accordance with Rule .1961.
II. 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 sews disposal syst@m on the above captioned property.
Type of system: ❑ Conventional Other k-K - ( `J Septic Tank: Z~'3 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3 feet ditches feet ditches inches
trench Drain Required: Linear feet
Authorized State Agent Date `
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