OP RNTE# 16-5.3--) Harnett County Department of Public Health 24748
PERMIT # ag3S4 Operation Permit
New Installation 1. Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: "1 : 401 IJ
Name: (owner) Qv ocllez� SUBDIVISION SrsEaa. o N sN t`s LOT # fc
System Installer. Toss A'\t-�LwS Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ CommuniPublic ❑ Well Distance from well feet
System Type: 'L7 A .. 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 Stxwtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Amhorstation
PERMIT CONDITIONS
I. Performance:
11. Monitoring.
111. Maintenance:
IV. Operation:
V. Other.
t
—41
� Ooca1N
St
D2
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NjX
If yes, see attached sheet for additional operation n
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E.Z5-i•-o w Septic Tank: LO 00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 0 ci feet ditches feet ditchestri —aa inches
French Drain Required: linear feet
Authorized State Anent \, w `--� ?(' 1 Date (0GP