opHTE# IS-5Harnett County Department of Public Health 23751
PERMIT # Operation Permit
New Installation 1�k Septic Tank k Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LO[ATION: 0-3C,&
Name: (owner)_H;)aSUBDIVISION C'jgxthc?57S LOT # Ib
System Installer. ,. .c QUA Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Commune Public ElWell Distance from well 00 feet
System Type: ] LL t Types V and VI Systems expire in S 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 Dispmal, and all conditions of the Improvement Permit and Construaian Authorization
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PERMIT CONDITIONS
I. 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 ❑ No'A
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other.
maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H201-ine
❑ PWR Line
Following are the specifications for
the sewage disposal system on�^t+he above captioned property.
Type of system: ❑
Conventional
X Other EZ \-1.(,a W
Septic Tank: 1000 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
dt
of each ditch 3C)o feet
ditches_ feet
ditches 1-30 inches
French Drain Required:
_Linear feet
Authorized State Agent flLahs Date