OP - ENVH cannot sign off in HTE - per VC until permits are purchasedHTE# fZ,— 5-3 ;.3 E Harnett County Department of Public Health
PERMIT # Operation Perpit 22656
I New Installation I/.J Septic Tank Q' Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: I5-Z!�i t'. ---c—
Name: (owner) SUBDIVISION LOT #
System Installer: TrlS i557uC & Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bums D(istance Type of Water Supply: El Community El Public l.� Well from well iw j feet
System Type: !r Ub4i i U76 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta& Health Department 6 months prior to expiration for permit renewal.
This system has been installed in
PERMIT CONDITIONS:
I. Performance:
II. Monitcior
III. Maintenance:
IV. Operation:
V. Other:
l
with applicable North Carolina General Statutes, Rules far Sewage Treatment and Disposal, and all conditions of the
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5ptem -stmt perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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Permit and Construction Authorization.
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❑ D -Box ❑ Pump ❑ Alarm ❑ 142O1-ine ❑
Following are the specifications for the sew a disposal system on the above captioned roperty.
Type of system: ❑ ConventionalOther' %�l��C.t Zt � Septic Tank: gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches A of each ditch Zoo feet ditches 3 feet ditches Z
French Drain Reouired: Linear feet
Authorized State A ! Date �'
PWR Line
gallons
inches