OP RHTE# i -s —y IQ1}-�z_ Harnett County Department of Public Health 24940
PERMIT #a�q �C1 peration Per g__
New Installation Septic Tank a Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: 31 1(0 0 S "301 (:!v- v\
Name: (owner) CLc�1\ SUBDIVISION LOT # 1
System Installer. ihC�yA s C -Cc Registration #
Basement with plumbing: ❑ Garage ❑ Number of)Bedrooms
Type of Water Supply: ❑ Community El -f Ic ❑ Well Distance from well P-2 feet
System Type: o 'S A s. Types V and VI Systems expire in S years.
(In accordance with Table V a) 0 ust contact Health Department 6 months prior to expiration for permit renewal.
Ihu 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 Authorization.
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PERMIT CONDITIONS
I. Performance:
If. 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 2'
If yes, see attached sheet for additional operation conditions, maintenance and reporfing.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dimon on the above captione
Type of system: El Conventional ❑Other �J 6 I IYLE— Septic Tank 1C)Q� gallons Pump Tank: gallons
Subsurface No. of exact length __j width of depth of
Drainage Field ditches S of each ditch I feet ditches _t feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ';745_Date CY3%2W-::,IcR�
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