OP RRHTE# 1,3-,5-- 3Z144Z
PERMIT # Z -7"5-&f
Name: (owner)
System Installer:
Basement with plumbing: El
Type of Water Supply: ❑ o
System Type: z
(In accordance with Tab V a)
This system has been insta d in com[
,� Harnett County Department of Public Health 23192
�� Operation Permit
E2 New Installation Septic Tank ZNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ay e,
SUBDIVISION LOT #
%S Registration #
Garage 12/ Number of Bedrooms 4130
unity Q/ Public ❑ Well Distance from well feet
d,w 117 6 &a-CA- Types V and VI Systems expire in 5 years.
Owner must c ntact Health Department 6 months prior to expiration for permit renewal.
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and
fit
h
S
V
16
PERMIT CONDITIO S: 1
I. Performan e: System shall perform in accordance with Rule .1961.
11. Monitorin : 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 t
V. Other: Q L 10
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the s a disposal system on the above captioned property.
ewa
Type of system: ❑ Conventional Other Z�5k — Septic Tank: c) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 13 3 feet ditches feet ditches f li inches
French Drain Required: Linear feet
Authorized State A nt -_ �.. Date