OP RH T E # ca.--''~-e >'l6 R- Harnett County Department of Public Health
PERMIT Operation Permit 2 2 2 4 5
New Installation ~K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W tt 1_ Lvc>" Rs,
Name: (owner) ~>i CL-.wt--(.. NA0k- 6 SUBDIVISION C.4*w.oL.)Ktv-, C3.P,,,5 LOT # 5_
System Installer: \ ~ -`~o>aEsS Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community , Public ❑ Well Distance from well 16O 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
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PERMIT CONDITIONS:
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 ❑
Following are the specifications for the sewage disposal system on the above captio property.
Type of system: ❑ Conventional Other Septic Tank: 100
Subsurface No. of exact length width of
Drainage Field ditches t of each ditch ZILC feet ditches -3
French Drain Reauired: _ ltd
H2OLine ❑
gallons Pump Tank: gallons
depth of
feet ditches 3L) inches
PWR Line
Authorized State Agent J`' Date
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