OP RHTE#/!7�1Z Harnett County Department of Public Health 24783
PERMIT #�_ 0 eration Per 't
New Installation Septic Tank 0 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOEATIO
Name: (owner) SUBDIVISIONLOT # ��—
v
System Installer: _ Registration #
Basement with plumbing: ❑ Garage ber of Bedrooms ._�3
Type of Water Supply: ❑ Community 2rPublic ❑ Well Distance from well feet
System Type: 6 Types V and VI Systems expire in S years.
(In accordance with Table 7a)p, 0wneLAuscent 6 months prior to expiration for permit renewal.
This system has been installed in ance wit7�ppl,.W� onh Caroli a General Statutes, Aule r Sewageage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I. Performance:
11, Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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I
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
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the se disposal�sYs�tem on thea ve captioned property.
Type of system: ❑ Conventional 7Other Z�"!ro Septic Tank: _LVQ O gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch.��� feet ditches 3 feet ditches ZH
trench Drain Required: Linearfeeta
Authorized State < Date
PWR Line
gallons
inrhp<
17-5-41616R (1)
17-5-41616R (2)
17-5-41616R (3)
17-5-41616R (4)
17-5-41616R (5)
17-5-41616R (6)
17-5-41616R (7)
17-5-41616R (8)
17-541616R (11)
17-541616R (12)
17-541616R (13)
17-541616R (9)
17-5-41616R (10)