OP RRHTE#09-5_- ~%C~'eg Harnett County Department of Public Health
PERMIT # as"9 Upera"0" ~P'e~r~m-i-t 21541
New Installation Imo' Septi Tank Nitrification Line ❑ Repair ❑ Expansion
/ PROPERTY LOCATION:
L~ r4 ee
Name: (owner) C ~~f k<a, ~7` ^ SUBDIVISION C_ kn.
System Installer Z?, rJ LOT #
Basement with plumbing- ❑ Garage ❑ umber of Bedrooms Registration #
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well
System Type: ' ~ feet
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 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 Authorizati
on.
,
E
I
j I
y f L(
ra
cl
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
IV. Operation:
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
~ !7 ,Zcl c ~
V. Other.
X 1, L4
❑ D-Box ❑ Pump ❑ Alarm ❑
H20Line ❑
following are the specifications for the sews disposal system on the ab a captiop ed property.
T
e of s
st
❑ C
PWR Line
yp
y
em:
S
b
f
onventional Other 4! -c, b C' s. 5 C,-
Septic Tank
ll
P
u
sur
ace
Drain
fi
ld
ga
ons
ump Tank:
No. of exact length width of
d
h
-
gallons
age
e
French Drain Re
uired:
ept
of
ditches
of each ditch '30,57
feet ditches feet ditches
q
Linear feet
inches
Authorized State Agent
/
Date
mss= ~~~rc~~
Wow
r
17 { t~
Jij;
JN'r N11
1C
R
1
e L
e