OP RRHTE# t2- A05d5dw- Harnett County Department of Public Health 25066
PERMIT # "Dc`)4r13C) 0 eration Permit
New Installation Septic Tank � Nitrification Line 11 Repair ❑ Expansior
PROPERTY LOICATION: SCV95 P aK,—O)ca.�6
Name: (owner) QbvTL-062S SUBDIVISION LOT #
System Installer. Cars,. Registration #
Basement with plumbing: ❑ Garage '5K Number of Bedrooms.5
Type of Water Supply: ❑ Community Public ElWell Distance from well feet
System Type: „1`1 - 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
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ✓ Conventional 'S� Other
Subsurface No. of exact length
Drainage Field ditches l'); of each ditch � feet
H2O1-ine ❑
Septic Tank: gallons Pump Tank
width of depth of rd�
ditches 3 feet ditches _
French Drain Required: Linear feet
Authorized State Agent x'15 Date 5 15 I$
PWR Line
gallons
inches
19
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