OP RHTE# Harnett County Department of Public Health 23314
PERMIT # Q`—?`1�` Operation Permit
New Installation ❑ Septic ank X Nitrification Line Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Q o �►aP �'z'�t'' ' SUBDIVISION LOT #
System Installer: 'Nvteit=..a \j t--t Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Ov-, - %L:os>a4 1 nt„t5vLy
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well feet
System Type: l 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: 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 ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above c ptioned pRperty.
Type of system: ❑ Conventional Other Septic Tank:
Subsurface No. of exact length width of
Drainage Field 'i her _ of each ditch ® feet ditches
French Drain Reauired�. ~Li�tea
Authorized State Agent Date --7
11-12O1-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditchesC "L�2-, inches
c�
tA
1�
7
CO
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 ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above c ptioned pRperty.
Type of system: ❑ Conventional Other Septic Tank:
Subsurface No. of exact length width of
Drainage Field 'i her _ of each ditch ® feet ditches
French Drain Reauired�. ~Li�tea
Authorized State Agent Date --7
11-12O1-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditchesC "L�2-, inches
�3�5- 32s���.,