OPi )1 Harnett County Department of Public Health
PERMIT # a Operation Permit 2 2 7 5 0
New Installation .:5k Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C-,A JQC11`
Q-D
Name: (owner) ' ~~t?t~•~' SUBDIVISION C--rc - LOT #
System Installer: ir,_--etj Registration #
Basement with plumbing: ❑ Garage 'Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well i00 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
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nti
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Reouired:
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sewage disposal system on the wove captioned property.
Other ~Usy'~ 2.. 1.~Crw Septic Tank: 1000 gallons Pump Tank: 10W gallons
exact length width of depth of ~,FF~
of each ditch feet ditches feet ditches V8-d40 inches
Authorized State Agent Date 11-7 1
IZ-