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HTE# 1-7'5--11- Harnett County Department of Public Health 24890
PERMIT# Operation Permit
New Installation ', Septic Tank )5< Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: naA US t 1-a,l
Name: (owner) Dtky.d N) --R 9 Pacz:-rvCSt6 SUBDIVISION Me.MsE g&;l-z- Q.\pr.E LOT #
System Installer: 1, , [cuss oro 5 c.ymbt.a re Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms
Type of Water Supply: ❑Community*4 Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) J 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 Swtutes, 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.
II. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E:2— u w Septic Tank: 6000' gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _� of each ditch feet ditches 3 feet ditches 1'8 inches
French Drain Required: Linear feet
Authorized State Agent 105 Date f 1211%
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i 1 Lp�r.{ }SOw iN b � orJ D(2�
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D•Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E:2— u w Septic Tank: 6000' gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _� of each ditch feet ditches 3 feet ditches 1'8 inches
French Drain Required: Linear feet
Authorized State Agent 105 Date f 1211%
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