OP RHTE #i "�� 3y'3��jP, Harnett County Department of Public Health 23539
PERMIT #� Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: �c,a
Name: (owner) ov��� Sc��, �Hc_ SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage 1< Number of Bedrooms
Type of Water Supply: ❑ Corn Public El Well Distance from well ®� 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
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,,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the s_evyage disposalsystem ontheabove captioned property.
El of system: Conventional /C9, Other E L Septic Tank:
Subsurface No. of exact length width of
Drainage Field of each ditch 3 1 0 feet ditches _
French Drain Reouired: _"��® Linear feet
H2OLine ❑
PWR Line
®4® gallons Pump Tank: C)00 gallons
depth of
feet ditches } r _ inches
Authorized State Agent -)___ _ _ Date
ldi 1
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Nous£ l.i
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PERMIT CONDITIONS:
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,,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the s_evyage disposalsystem ontheabove captioned property.
El of system: Conventional /C9, Other E L Septic Tank:
Subsurface No. of exact length width of
Drainage Field of each ditch 3 1 0 feet ditches _
French Drain Reouired: _"��® Linear feet
H2OLine ❑
PWR Line
®4® gallons Pump Tank: C)00 gallons
depth of
feet ditches } r _ inches
Authorized State Agent -)___ _ _ Date
ILA