OP REPAIRHTE# �ZEPC��2 C�� -�3� �� Harnett County Department of Public Health 23419
PERMIT # 2.�0�� Operation Permit
llati" ❑ Septic Tank >� Nitrification Line X Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) QN- NgN- >N 0?1�62- S i H SUBDIVISION LOT #
System Installer: '2.C.G'hto.Lp (::�K2.xE. tti Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well td Q) feet
System Type: = c 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
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
IV. Operation:
V. Other:
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ;� Other'2'ic�w
Subsurface o. o exact length
Drainage Field ditches 3 of each ditch 5 feet
French Drain Require
Alarm ❑ H2O1-ine ❑ PWR Line
Septic Tank: � I s's � �J$ gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches Zt °3 6 inches
Authorized State Agent K66 \ S Date
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