OP RRHTE# J1-5-a05\' QD_ Harnett County Department of Public Health
PERMIT #Operation Permit 2 21 2 2
New Installation Septic Tank Nitrification Line ❑ Repair El Expansion
o~~ ~ 410L
PROPERTY LOCATION: p
Name: (owner) ~-:)o v SfNe5 SUBDIVISION (1-Qo e.N r4a a 05 LOT # 1~)
System Installer: tp ZQ~ 0 Registration #
Basement with plumbing: ❑ Garage )<Number of Bedrooms j
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well ,GO 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:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)~
IV. Operation:
V. Other:
If yes, see attached sheet for additional operatio conditions, maintenance and reporting.
❑ D-Box
Following are the specifications for
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Required•~
❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
captio captioned property.
the sewage disposal system on the above
Other mss- S l~ d k Septic Tank: 0~® gallons Pump Tank: gallons
exact length width of depth of
of each ditch `5o feet ditches feet ditches ~ 4C inches
Authorized State Agent _11 \ \ Date