OP RRHTE #fit -� t� Harnett County Department of ulic Health 23301
PERMIT # Operation Permit
1 New Installation Septic Tank Nitrification Line El Repair El Expansior
x PROPERTY LOCATION: ,4 �v���� s
Name: (owner)r? - -- °'
System Installer:
Basement with plumbing: ❑ Garage Number of Bedroom
Type of Water Supply: ❑ Community Public ❑ Well
System Type: 1 c
(In accordance with Table V a)
SUBDIVISION o,g- :� LOT # \(Z)
Registration #
Distance from well IC)C feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
finis system nas peen mstanea in compnance witn apphcaoie nortn Lamina uenerai statutes, HIM for sewage oreatment ana uesposai, ana an conatvons or me improvement rermtt ana Lonstructnon Authorization.
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
VA 0 u5E.
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 operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the ewage disposal stem on the above captioned property.
Type of system: ❑ Conventional Other t--'2—' �—, - -Y l Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 150 feet ditches feet ditches inches
French Drain Required—e—'-,, Lm eet
Authorized State Agent : � -� -. Date '�- I I I m
1`° S° ��5-)3tt