OP RHTE# 10 -5 ~ ~Q-- Harnett County Department of Public Health
PERMIT # a~ NLA Operation Permit 21 6 0 5
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: R~Qe
Name: (owner) S~ ~L NOrnt, v ,--cEQ-5 SUBDIVISION Q LOT # a
System Installer: 'TE o fLow r+ Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community ,'156Public ❑ Well Distance from well lb feet
System Type: --J~E 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.
finis 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 rnNnITInNC-
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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for th sewage disposal system on the abovf captioned pr
Type of system: ❑ Conventional X Other GNAP\m4~ I! ~c Septic Tank: 1 COO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch aaS feet ditches feet ditches inches
French Drain Reauired: Iina~TVnnt
Authorized State Agent Date Z k36 ~ k C)
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