OPHTE#_`Q-,S-- , 5-c 6 Harnett County Department of Public Health
PERMIT # I q O
Name: (owner) i rc ® c ak~
System Installer: IG C l asp
Basement with plumbing: ❑ Garage ~ umber of Bedrooms
Type of Water Supply: ❑ Community V public ❑ Well
System Type:
(In accordance with Table V a)
Operation Permit 21 81 0
New Installation Cr Septic Tank EfNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:s )iQ
SUBDIVISION A ,,,,j7 LOT #
Registration #
Distance from well feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
INS system has been mstabea to compliance with appbcable north tarohna ueneral mtutes, Wes for sewage treatment ana msposai, ana an conamons of me improvement rermit ana Unstrucaon numorization.
~icra
MCA 1461
r 6-~
of !L--J 8,
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: El Conventional Other E rf"I" Septic Tank: / (yj (i
Subsurface No. of exact length _ width of
Drainage Field ditches 3 of each ditch feet ditches 3
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches (I' inches
French Drain Required: Linear feet
Authorized State Age t C~ Date 1 p Xcle
/ c) - s - ~2-j-csp-,