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PERMIT # a 3
Name: (owner) 0 1
System Installer: ~rzr~
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type:
(In accordance with Table V
This stem has been installed in compliance
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Harnett County Department of Public Health 21376
Operation Permit
(5K-'New Installation JW Septic Tank ❑ Repair &i~ Nitrification Line ❑ Expansion
PROPERTY LOCATION:_ C ` 1
SUBDIVISION- (~nc_~~~~~~ LOT#
Registration #
Number of Bedrooms
Z Public ❑ Well Distance from well J.3 feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operatio o
Permit and Construction Authorization.
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maintenance and reporting.
Following are the specifications for the sew e disposal ryj* on the above ca tioned property.
Type of system: ❑ Conventional 1 Other 4 '
Subsurface No. of Septic Tank: _ gallons Pump Tank gallons
exact length width of depth of
Drainage Field ditches of each ditch -)I i6 feet ditches )
French Drain Required: Linear feet feet ditches ) i I -
Authorized inches
Authorized State Agent Date
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