OP RHTE# 13" 5 � Harnett County Department of Public Health 23281
PERMIT # � S Operation Permit
New Installation '>ij Se tic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) C" �A yrt�-, i.1-E0 SUBDIVISION Q0,o-gt r1, LOT #
System Installer: 5 -AwzRE Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J
Type of Water Supply: ❑ Community N Public ❑ Well Distance from well 10 ® 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.
PERMIT CONDITIONS:
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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1 oLa C--,�,1,9 Septic Tank: 1 0 G gallons Pump Tank:
Subsurface o. exact length width of depth of
Drainage Field ditches of each ditch S feet ditches feet ditches
French Drain Required: �e �'�, feet
� Authorized State Agent
PWR Line
gallons
inches