OPHTE# /a 1Z bI"-/ Harnett County Department of Public Health
PERMIT # cZ e-2 Operation Pewit 22351
2/New Installation 10Septic Tank C"Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) v~ C t f~r~ a SUBDIVISION i 4'1- j- CD ~w s e_ LOT # 13
System Installer: 1`_k tLoAr PA4 Registration # 41
Basement with plumbing: ❑ Garage 2r Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1~ 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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YtKMI I IUNU111UNS:
1. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew
ag~ disposal system on`Oe above captioned property.
Type of system: 11 Conventional in Other Septic Tank: °O Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -700 feet ditches3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent`s c~ Date f'_/ &12,a1.Z
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