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Harnett County Department of Public Health
24949
PERMIT # r -t �
Operation Permit,-
.
New Installation eptic TankiL4�N trification Line ❑
Repair ❑bRR\ansion
PROPERTY LOCATION: �' 906 (Zx, dour, 2s�.
C,� a'
Name: (owner)
SUBDIVISION
T
LOT #
System Installer. (N
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Registration #
Basement with plumbing ❑ Garage
❑ NDO of Bedroa
86'
Type of Water Supply: ❑ Community
ublic ell
ll
Di ^ well
stance r feet
System Type:
!t),:5 Eem
� Types V and VI Systems expire in S years.
(In accordance with Table V a)
Owner must contact Health Department 6 months prior to expiration for permit
renewal.
This system has been installed in camoliance with
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icable North Carolina General Stammer, Rules for Sewage Treatment and Disposal, and all conditions of the It
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Permit and Construction Authorization.
5u Pea.ruN�- St�'Ean�j
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PERMIT CONDITIONS: v 5 ern jti�� o G� I5 aC
1. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring. As required by Rule .1961. t',�r�P p fl�I19IabI
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 ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sewage sal system on the above captioned property.
Type of system: ❑ Conventional r� FIC', 11L -O Septic Tank: 1 Y'i gallons Pump Tank: _14X"b gallons
Subsurface No. of exact lengthf width of depth of
Drainage Field ditches of each ditch J i] feet ditches 3 feet ditches inches
french Drain Required: Linear feet
Authorized State Agent ��� Date 04h I cig
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