OP1 Harnett County Department , Public
23315
PERMIT # ���! �� OlDeration Permit
New Installationl Septic Tank Nitrification Line ❑ Repair E] Expansion
PROPERTY LOCATION: QC—\J . CN'vtLZ
Name: (owner) trNy NcLa-,5(3N SUBDIVISION LOT #
System Installer: 1___ —i `:—> n Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community �< Public ❑ Well Distance from well 1 (00 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:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑
Following are the specifications for the sewage disposal system onAe above captioned property.
Type of system: El Conventional Other 5Qx;�. Septic Tank: t t cQ� i gallons Pump Tank:
Subsurface - -No._ ff- � exact length width of depth of
Drainage Field ditches -� f each ditch 13 3 feet ditches feet ditches 0,4 30
French Drain Reouired: 10-ear
Authorized State Agent �\` �`��� ����� Date
PWR Line
gallons
inches