OPNTE# 1 Harnett County Department of Public Health 24936
PERMIT # a`Y:76 '�7 motion Permit,
2-1ew Installation �Sepfic Tank 911i�trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rice) mc:'�b Ln oa -,?C,I ati�
Name: (owner) Ken new gcn 41o^4ns, SUBDIVISION LOT # f4,4t
System Installer. q Registration #
Basement with plumbing: ❑ Garage umber of �Bedrf�^�s
Type of Water Supply: Ll Community El Public Lad' Well Distance from well 100+ feet
System Type: -5`%� Rrhxkic n s :� Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner t contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina Genenl Sutures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conctmciion Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
11. 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 osal system on the abo�ve c tl property.
Type of system:
❑ Conventional Eir Other
67-
Septic Tank: t OCfJ gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of ,^f
ditches ..7--
exact length
of each ditch a Lily feet
width of depth of
ditches feet ditches inches
French Drain Required: linear feet
Authorized State Agent G — ��/i� Date LA 11Gi `o1�1Y
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