OP RRHTE# D~j-533-mil ► R2 Harnett County Department of Public Health 2 0 9 7 2
PERMIT # o~ Operation Permit
/I- New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) ,/1 SUBDIVISION l &LOT #
System Installer Registration #
Basement with plumbing ❑ Garage Number of Bedrooms
Type of Water Suppl ❑ Community Public ❑ Well Dista c from well feet
" 14
System Type: v'
Types V and VI Systems expire in 5 years.
(In accordance with Table Via) 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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DCDYIT fA~IDIT1A ~If.
1 X111111 \.VI~YI. -J.
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 operatio c
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the 70 disposal tem on the above captioned property.
Type of system: ❑ Conventional ther 1Z n..0 j - S~ t (1 l.~ Septic Tank: )0 gallons Pump sank. 7 gallons
Subsurface of exact ength width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required;, _ * . ear feet
Authorized State Agent :~s Date I) ))3
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