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S~~~75 Harnett County Department of Public Health 2 0 9 2 5
PERMIT # Operation Permit
ei--New Installation CR_..Septic Tank ❑ Repair .[Nitrification Line ❑ Expansion
N PROPERTY LOCATION:
Name: (owner) .~~AAr~ SUBDIVISION /1v ~ ,~sCt LOT #
System Installer: L Registration #
Basement with plumbing: ❑ arage F71- Number of Bedrooms
Type of Water ply: ❑ Communi Public ❑ Well Distance from well 103 feet
System Type: f, G - Types V and VI Systems expire in 5 years.
(In accordance with Table V a) C 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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1. Performance: System shall perform 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.
French Drain Required: Linear feet
Authorized State Agent Date O
Following are the specifications for the sewage disposal sys m on the above captioned property.
Type of system: ❑ Conventional ~Other ~ 0- t 2 E Septic Tank: 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches - feet ditches inches
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