OP RHTE# /0-S Z3io]j Harnett County Department of Public Health 21 0 3 9
PERMIT # 21:2 1 & 0 eration PeI-t
VNew Installation Lv1 Septic Tank ❑ Repair LNitrificatio
n line ❑ Expansion
Name: (owner) PROPERTY LOCATION:
To% SUBDIVISION Yr ~ .
System Installer, ke~,,,r ;(q~ ~ LOT #
Registration
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ,3 #
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well
System Type: 7G, feet
96D'rrt Types V and VI Systems expire in 5 years.
(In accordance with Tao, 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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100
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PERMIT CONDITIONS:
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.
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Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other Js"a/o .u+.,.
No. Subsurface onv of ` ptic Tank: Zq-~ gallons Pump Tank allons
f exact length width of g
Drainage Field ditches of each ditch Z `lO depth of
French Drain Required: feet ditches feet ditches t K
Linear feet inches
Authorized State
P, Z%e~'
Date l -15
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