OP RRHTE# +0--!5- n. Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 6 4
j New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: \Awy
Name: (owner) Q, t,L i -o9, c3 4 SUBDIVISION GW~a~I ~~ks LOT # 5?
System Installer: Q>v Registration #
Basement with plumbing: ❑ Garage 'Ii~ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well i (25b 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
~36~ /~Slo ~ I
w
Q r
fld boa.
rcnra t t ONH iONz
1. 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 ❑ Nox
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other Pv me To 7--2• Tt- N! Septic Tank: 1000 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches
French Drain Required: i ftw feet
PWR Line
gallons
inches
Authorized State Agent w~\?l5 Date t