OP RHTE# /a Y-ae"IJ-C,R Harnett County Department of Public Health
PERMIT # d b I n Operation Permit 2 2 3 6 3
E2r New Installation Z~Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) t)~aL.\ C0A r4P1J4, Q1, SUBDIVISION Czo LOT # 3~
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well- Distance from well feet
System Type: LLL G 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.
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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sews
disposal system on the above captioned property.
Type of system: ❑
Conventional O
ther eZ Flo ---I Septic Tank: l UC90
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
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3
depth of
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Drainage Field
ditches
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of each ditch
feet
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French Drain Required: Linear feet
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Authorized State Agent ~ Date ' /l 9 LZZ°
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