OP RHTE# Harnett County Department of Public Health
PERMIT Operation Permit 22849
New Installation 'N Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NQ Q`
Name: (awner) ��%) �.{j g�tv;4i,) h _5 SUBDIVISION C,�-,,3 E,,j Q) ]K<� LOT # 100-
System Installer: -T,S, Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 feet
System Type: 'Yo 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
rtKMI I IUNUI I IUN):
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:
❑
D -Box
1V o V5E
H2OLine ❑ PWR Line
Following are the specifications
for
the sewage disposal system on the above captioned property.
3
Conventional
Other _ P V M- v E—L Septic Tank:
1 00 0 gallons Pump Tank: 10 00 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch 100 feet ditches
30' 1
vrq"
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N Gyl Q
rtKMI I IUNUI I IUN):
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:
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Other _ P V M- v E—L Septic Tank:
1 00 0 gallons Pump Tank: 10 00 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch 100 feet ditches
feet ditches inches
French Drain Reauired:
n--
reset
Authorized State Agent N _ y41aS Date _ _? 1 a-;)�
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