OP RHTE# /d' J-- 0, ~-6 77,e Harnett County Department of Public Health
PERMIT # k- 1 V Operation Permit 21811
ET Installation Septic Tank Q""Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I tcd, ~
Name: (owner) -`P~t Cc SUBDIVISION LOT # D? Z
System Installer: 6c'".c Registration #
Basement with plumbing: ❑ Garage 2"'Number of Bedrooms 3
Type of Water Supply: ❑ Communi 2"'Public ❑ Well Distance from well feet
System Type: ( 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
rcnrni 1 Wnun1Vn3:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑
D-Box ❑
Pump ❑ Alarm
❑ H201-ine ❑ PWR Line
Following are th
e specifications for the sews
disposal system nAhe above captioned property.
~
"
Type of system:
❑ Conventional O
ther
4 r
!l
Septic Tank: -4 gallons Pump Tank gallons
Subsurface
D
i
Fi
No. of
-
exact length
width of depth of
~
ra
nage
eld
ditches
of each ditch feet
ditches -
feet ditches inches
French Drain Required: Linear feet
Authorized State Agent 'r
t - /i! Date Z';~ 2 cf
s ecilicatlon ~
eels Ihe`~c chtp '
the Feel Glade toca;ion~Sa m~02 03R lot We
chips is tcoma t s~sly'r, alp n fields.
C to"d of t to a Ntitcitica.to
In
Zhi , ,;lr ova Sale
s° Oclc P59~e9
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