OP RHTE# 1/- 5-- &V" W- Harnett County Department of Public Health
PERMIT # Z-65-1 Operation Permit 2 2 0 6 9
L~ New Installation c Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ q/~-
Name: (owner) - SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: s „rz..i!s 6 47 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
North Carolina General Statutes, Rules for
Treatment and
and all conditions of the mprovement Permit and Construction Authorization.
PERMIT CONDITIONS: Wit-
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional ; Other 7~;01,6 b VC Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches- of each ditch 00 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State ent Date
e-- 13, 9
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