OP RNTE# f1—s'alticx,� Harnett County Department of Public Health
a�iao� 24140
PERMIT # ration Permi
New Installation Septic Tank tion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: '3r-(, �r . CciNt >cduk na sL r�
Name: (owner) t-2:�r o a r� SUBDIVISION 51i�l LOT # S q
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms S_�
Type of Water Supply: ❑ Community ❑ ❑ Well Di tante from well 1vJ�c feet
System Type: a'%`�% h x 5 s- l� Types V and A Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ibis system has been invalled in compliMe with applinble North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conswaion Authododon.
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PERMIT CONDITIONS: �' r
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 sewage dis I system on the above captioned _property.
Type of system: ❑ Conventional ther � y =�- r f o �J�"1�—b Septic Tank: 1 gallons Pump Tank: 1?56 gallons
Subsurface No. of r j exact length width of depth of
Drainage Field ditches 7' of each ditch feet ditches 3 feet ditcher c?O i.A.,
French rainRequired: Linear feet
Authorized State Agent '- Date 01
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