OP RATEO-5 — 5- 3)15'0T& Harnett County Department of Public Health 2 3 0 6 5
PERMIT # ��'�- 0 eration Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) C.+> e2, SUBDIVISION QC-3-N "a v\14 c QZS-e Su t, LOT # 1'85
System Installer: C o V N Registration #
Basement with plumbing: ❑ Garage �X Number of Bedrooms 5
Type of Water Supply: ❑ Community P� Public ❑ Well Distance from well Vt(3 feet
System Type: t 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
PHMII LUNUIIIUM:
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 ❑ N
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: El Conventional Other CJP '�N Septic Tank: la p gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches - of each ditch feet ditches feet ditches A inches
French Drain Required: — - --bt+wJeet
Authorized State Agent `�, � ���' �� =rte Date � t