OP RHTE# 10-J-- aY(. sS-e Harnett County Department of Public Health
PERMIT # 7Z~+1 63 0 erat*on Perm'
e mit 21 7 61
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C ff; It ed.
Name: (owner) C cs ~,r SUBDIVISION LOT # /,7,
System Installer: T d Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms -7
Type of Water Supply: ❑ Community C1~Public ❑ Well Distance from well feet
System Type: 2 Cr- 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.
apmni 1143 neon nmtanea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
PERMIT fnNnITIMA-
and all conditions of the Improvement Permit and Construction Authorization.
I. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine Fr' /o(z1 to h PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other ~ C k C kc,-r~b , - Septic Tank: M 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch / `2 feet ditches J feet ditches 7 inches
French Drain Required: Linear feet
L
Authorized State Agent Date Il /4, 4cr tl
/ o -fir- "L--`{ C 7[5/-