OP-* Harnett County Department Public
PERMIT # �� Operation Permit
New Installation X, Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Vow l
Name: (owner) �atr� , ��� SUBDIVISION S,,wN L-W)3 O4-t. LOT #
System Installer: ,,, 5, ct,.c -,c a., p` Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communi Public El Well Distance from well 1 d� feet
System Type: 11 �R 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 far Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
FIRM! Wn1UIi U113.
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NI, K
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches —4—
French Drain Required:
maintenance and reporting.
. Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
sewage disposal system on the above captioned property.
Other PU M �� 0 �La Septic Tank: a gallons Pump Tank:[ b gallons
exact length width of depth of
of each ditch feet ditches feet ditches inches
Authorized State Agent 1AS Date I-O 1 a.1
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FIRM! Wn1UIi U113.
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NI, K
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches —4—
French Drain Required:
maintenance and reporting.
. Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
sewage disposal system on the above captioned property.
Other PU M �� 0 �La Septic Tank: a gallons Pump Tank:[ b gallons
exact length width of depth of
of each ditch feet ditches feet ditches inches
Authorized State Agent 1AS Date I-O 1 a.1