OP RHTE#//0--d, Harnett County Department of Public Health
PERMIT # Q b'-I Operation Permit 2 2 0 2 2
R1 R New Installation Septic jank Ll' itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: !Yt`~ d ~c e-ksr-k m
Name: (owner) A cs-r- tzJ' SUBDIVISION LOT # a
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms J J
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: 1L G 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.
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PERMIT CONDITIONS: IV C,
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Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No iZ
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are th
T
f
e specifications for the
❑ C
i
sew a disposal system on the above captioned property.
Z F/
ype o
system:
onvent
onal
ow
Other
Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of
3
exact length
width of depth of
Drainage Field
ditches -
of each ditch feet
ditches 3 feet ditches a inrhec
French Drain Required: Linear feet
Authorized State Age ,~G. C~
r
Date