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HTE# -71 R Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 H 7
Z'New Installation Septic Tank E"-Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~ a✓"~.+~-~d~~-
Name: (owner) SUBDIVISION LOT # k
System Installer: U-,-\/ ,A pack Registration #
Basement with plumbing: ❑ Garage Ir Number of Bedrooms I
Type of Water Supply: ❑ Community 2"'Public ❑ Well Distance from well feet
System Type:1 Cr Types V and VI Systems expire in 5 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 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: 1 t
1. 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 Efr
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewa disposal system on th above captioned property.
Alarm ❑ H201-ine ❑
PWR Line
Type of system: ❑ Conventional Z Other f_= -7 F A U-) Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No.~fi~ exact length width of depth of
Drainage field ditches of each ditch y~0 feet ditches 3 feet ditches 0 inches
French Drain Required
Authorized State Agent a6-00 Date H
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