OP RRHTE# j2,- &3oli) o Harnett County Department of Public Health 23031
PERMIT -d Operation Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: D o cc,:
Name: (owner) Yv-� r4 2.v c: SUBDIVIS10If LOT #
System Installer: S rwcn,!,' o tv 3 L' V n N Registration #
Basement with plumbing: ❑ Garage X Humber of Bedrooms L-')
Type of Water Supply: ❑ Community " Public ❑ Well Distance from well 1O c5 feet
System Type: 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 Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
rtnnil LUNUntuns:
I. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned ro erty.
Type of system: ❑ Conventional 'Other PU � , i ON-4 Septic Tank: t D Q> Q gallons Pump Tank: 1 0',) 0 gallons
Subsurface o. exact length width of depth of
Drainage Field ditches of each ditch W40 feet ditches feet ditches it inches
French Drain Required: __ Linear feet
Authorized State Agent \\ \�Nhlll\ Date ip / i—)
1 5-- 30416QL-