OP RHTE# 13- 5- 3e�5W'S(L Harnett County Department of Public Health
PERMIT # QL�71 Q01 Operation Permit 22547
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) GKL--i
System Installer: C?T; aiczg Asa
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well
System Type:
(In accordance with Table V a)
PROPERTY LOCATION: N tQS
'c.5 SUBDIVISION Q) g_ t O Pc 5 LOT #
Registration #
3
Distance from well 1 IZ30 feet
Types V and VI Systems expire in 5 years.
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: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ 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 ?_ w Septic Tank: a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 'raP �-
Drainage Field --- ' hes i of each ditch feet ditches feet ditches " 1Zli- inches
French Drain Required: _ - ear feet
Authorized State pent �y�= ��= + __ Date 5
a � ,. s.,3��a��: