OP- can not sign off in HTE -no step-permits not purchased per DonnaH T E # Harnett County Department of ublic Health
23395
PERMIT # 3.'?G Operation Permit
J New Installation �tlr Nitrification Line ❑ Repair XExpansion
PROPERTY LOCATIONA20� QP,``S,4
Name: (owner) °� Ec-'c' i�2s�,'s�� SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ', Number of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well feet
System Type: r 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.
Ibis 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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PLKMII CUNDIIIUNS:
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: E,, -,cLc SYSTi5n
t5 3 -,< SO
❑ D -Box ❑
Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals
stem on the above captioned property.
Type of system: ❑ Conventional Other
Z Jam. ®w
Septic Tank: F' tS5 INC
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches
of each ditches feet
ditches 3
feet ditches inches
French Drain Required.—
ear feet
Authorized State Agent \�,���� 5 Date 91,611