OP RRHTE# /SS'-3s"g3g1CA Harnett County Department of Public Health 23714
PERMIT # a6 0.7 _/ Operation Per It
L New Installation c Tank LAS Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: oto Y4v ed.
Name: (owner) Vi Kk SUBDIVISION e-rl +er LOT #
System Installer 13+-vj- Sir c /l (c,...d Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Ir -
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well feet
System Type: MI b 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.
chis 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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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 se dispos system n the above captioned yroperty.
Type of system: ❑ Conventional IJ Other �v✓�+.�> I< ��:r { Ch-,�+r Septic Tank: / So gallons Pump Tank: 1A SO gallons
Subsurface No. ofexact length width of depth of
Drainage Field ditches _� of each ditch -5_0(J feet ditches -" feet ditches Z;L- /6 inches
French Drain Required: Linear feet
Authorized State Age t e Date /0// ell, c1f
/f"s'-- 3.re -7 V/- A
339
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