OP RHTE# 15"'r— X5%zl2 Harnett County Department of Public Health 93
PERMIT # Z9-56 /Operation Pierit� � j
C" New Installation I� Septic Tank [J Nitrification Line � Repair Expansion
PROPERTY LOCATION:
Name: (owner)�?�%%.�.�. �-•� f'L SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: Garage E❑ mber of�Bedr0 3
Type of Water Supply: ❑ Community L Public L�' Well Distance from well 76 feet
System Type:'Ls �'`o / �fiZ,, wat-G nd VI Systems expire in 5 years.
(In accordance with Table V a) 6wner must contact Head Department 6 months prior to expiration for permit renewal.
[his 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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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:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwage/clIsposal system on the above captioned property.
Type of system: El Convent LX Other,__ Septic Tank: 1,04gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch s® feet ditches � feet ditches � inches
French Drain Required: Linear feet
Authorized State Ag � ���-' Date &I— / t—/ � "`