OP RHTE#_%s_~` Harnett County Department of Public Health 2 0 7 6 4
PERMIT # Or 0 eration Permit
New Installati~tic Tank ❑ Repair Nitrification Line ❑ Expansion
p PROPERTY LOCATION: 6
Name: (owner) l J SUBDIVISION 7W {-e. ~ LOT # ) V
System Installer. "Registration #
Basement with plumbing ❑ Garage >6 Number of Bedrooms
Type of Water S I . ❑ Community Public ❑ Well Distance from well feet
System Type= Types V and VI Systems expire in 5 years.
(in accordance with Table a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North (arolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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maintenance and reporting.
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Following are the specifications for the sewage disposal s tem on the above c toned property.. /
Type of system: ❑ Conventio I Other 0 ill 5 t Septic Tank: _ QD gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ach ditch , feet ditches feet ditches inches
French Drain Required: \ r \
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PERMIT CONDITIONS:
1. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring:
As required by Rule .1961.
111. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No"
N yes, see attached sheet for additional operation k
IV. Operation:
V. Other.
Authorized State Agent Nl~ v QSr"'~ ~ Date c) 1-a~ 10
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