OP RHTE#-7,LI 2 Harnett County Department of Public Health 19674
PERMIT # ~"1 t dpefatlU(i Permit
,2 New Installation ;0 Septic Tank ❑ Repair-i~j Nitrification Line ❑ Expansion
PROPERTY 1.00110f .
Name: (owner) ~r -s'~(1"a (-t,,'-'t~ SUBDIVISION S i v~ l\ JOT # Z-1
System Installer. 121 Registration #
Basement with plumbing: ❑ Garage 'E1 Number of Bedrooms _3 Type of Water Sup&- ❑ Community ® Public ❑ Well Distance from well >J feet
System Type: ~ J . 4 t{ t i T 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 tats bem untatled in compliance with apouble North Carolina Getserat sutures, Wes for Sewage Treatment and Disposal, and al -conditions of the Improvement Permit and Commxtion hdorirtioi
PERMIT CONDITIONS:
I. 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 0)
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal tem on the above captioned property.
Type of system: ❑ Conventional )10 Other - ~ " 'A Size of tank: Septic Tank:
Subsurface No* of exact length Z width of
Drainage Field ditches of each ditch ✓9D feet ditches _
French Drain Required: linear feet
Authorized State Agent kA -
gallons Pump Tank: gallons
3 depth of
feet ditches Z inches
Date 2 -1-2 ~ - 0