OP RHTE#-Ia Harnett County Department of Public Health 23129
PERMIT # �.—a�5�- Operation Permit
New Installation X Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: >'�)e_ i,._p
Name: (owner) SUBDIVISION it Qa, v� ��on ,,� LOT # 'o�
System Installer: ®ti ,+.ate.sJt c r�� Registration #
Basement with plumbing: ❑ Garage �K Number of Bedrooms L—
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 108 feet
System Type: m= -- 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.
rLnrni IMIUMV113.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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`s'
If yes, see attached sheet for additional operatio�Jn''co``nditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dispos system on the above captioned property.
Type of system: ❑ Conventional Other CZ 4.G^'[ Septic Tank: 1 00 Q% gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field idicfT8 of each ditch feet ditches feet ditches inches
French Drain Required., ,- 'near_e
Authorized State Agent q_---ras Date v i a-'i I lam°)