OPHTE#t7-s-Harnett County Department of Public Health 24897
PERMIT # a`���� Operation Permit
New Installation R Septic Tank '>d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: rai9.pi Dn.,ve_
Name: (owner) SUBDIVISION Q„te.. C.wss+N. c LOT # IV
System Installer: C�),vs Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community eg Public ❑ Well Distance from well feet
System Type: _'C'i2 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
fm system nas been installed in mmphame with applicable North Larolma beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
YtNMn LUNUn IONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, 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 "Z S^ieu Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch 110 feet ditches 3 feet ditches 30-17 inches
French Drain Reouired: Linear feet
Authorized State Agent F,- Date t
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