OP RHTE#O-7 F'aX9 DR, Harnett County Department of Public Health
PERMIT # Operation Permit 21 5 7 8
New Installation X Septic Tank X Nitrification line ❑ Repair ❑ Expansior
PROPERTY LOCATION: 1<~iL~f P~r,
Name: (owner) C~~ ors 1~~~ cz SUBDIVISION LOT # I
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'tW, Public ❑ Well Distance from well 5 O feet
System Type: 7; ~ 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
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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.
3L+a
Permit and Construction Authorization.
❑ D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other E Z- VLov✓ Se tic Tank: s 04 d
Subsurface No. of p gallons Pump Tank: gallons
exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches
French Drain Required: inches
Authorized State Agent Date 411 a