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Harnett
County Department of Public
Health 2 Q 6 9 7
PERMIT # arq'A
Operation
Permit
~
LR New Installation - Septic Tank ❑
Repair nitrification Line ❑ Expansion
PROPERTY LOCATION: ~~M~sQI A
Q r V-XJ
Name: (owner) 144 14 C
Q=.S'jr0 r_1; VA
SUBDIVISION (71~ms-- (0,-r
Pk 3 LOT #
System Installer. C+ :a 541_,t kt_"
Registration #
Basement with plumbing: ❑ Garage
[.KN mber of Bedrooms
Type of Water Supply: ❑ Community
L Public ❑ Well Distance from well feet
System Type:
7y G"
Types V and VI Systems expire i
n 5 years.
(In accordance with Table V a)
Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ihrs 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
5 ~
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rtmin cvnulnvn):
1. Performance: System shall perform in accordance with Rule .1961.
II. 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.
Following are the specifications for the sewage)lsposal system on the above captioned property.
Type of system: 11 Conventional R' Other E2- t- 11'1., Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length C f width of depth of
Drainage field ditches of each ditch °2 7 6 feet ditches feet ditches `2 inches
French Drain Required: Linear feet
Authorized State Agent Date 7 T/.2cril
09.5- ~_kt~ti1
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