OPHTE# /`0- 1,7�-73„j Harnett County Department of Public Health 931 n7
PERMIT # Qj 8oP Operation Permit
New Installation [� Septic Tank ET"'Iditrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION,&��� LOT # 7 y
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms --
Type of Water Supply: ❑ Community K— Public ❑ Well Distance from well feet
System Type: —,-7T— C.- 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.
ims system nas Deen mstaueo 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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PERMIT rnidnITIAW.
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 sew disposal system on the above captioned property.
Type of system: ❑
Conventional Other E ZFla,j Septic Tank: /QQQ
gallons Pump Tank: gallons
Subsurface
No. of exact length width of
depth of
Drainage Field
ditches _ of each ditch Q feet ditches 3
feet ditches c7(Q inches
French Drain Required:
Linear feet
Authorized State AgerN° ' �`/, - / fff Date
y� V12- al 5/
Y-r=�rk-7 -17 ?