OP RRHTE# \ D, - Harnett County Department of Public Health
PERMIT # Operation Permit 22820
New Installation Lk Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C.i�,
Name: (owner) CO 9,,QS7 R'5 SUBDIVISION Q c)rr; LOT # 0
System Installer: Q-T ) -, NQ Registration #
Basement with plumbing: ❑ Garage ( Number of Bedrooms
Type of Water Supply: ❑ Community APublic ❑ Well Distance from well 1Z) 0 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
PERMIT CONDITIONS:
I. 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:
\J%Q
—Na
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal
on the above captioned property.
Type of system:
- �system
El Conventional Other i
U ® EZ slct , Septic Tank: 0-S-0
gallons Pump Tank: 12S'0 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches 1
of each ditch 3 7 feet ditches
feet ditches 1 V'3i inches
french Drain Required:
Authorized State Agent Date 1
vI 5- A-1) oaV-tZ