OP RRHTE #Q —) '5 °1`1b5C'1(Z0- Harnett County Department of Public Health
PERMIT # �`3 Neration Permit 21640
r New Installation '�S, Septic Tank `�K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Eiw�)
Name: (owner) 9\ SUBDIVISION �,) tx' UQ , -c zc ,aS LOT #
System Installer: 1 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms a
Type of Water Supply: ❑ Community *ST , Public El Well Distance from well 1 feet
System Type: �•-P 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.
fms system nas peen installed in compliance wim appucaoie norm Laroima ueneraf statutes, nines for sewage treatment and usposai, and all conditions of the
PERMIT CONDITIONS:
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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
rermit and lon5trucnon Autnorizatlon.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned pro erty.
Type of system: El Conventional '1!Z Other RU \'' (- o \ v,caz'�) Septic Tank: gallons Pump Tank: 1 0'710 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch a 1 feet ditches 3 feet ditches ) inches
French Drain Rep ' ear feet
Authorized State Agent Date i `?