OP RH T E # 'F ),4 J Q ll IC' Harnett County Department of Public Health 21151
PERMIT '/s7 0_peration-Permi-t
ew Installation l~~ Septtc Tank ❑ Repair B'Nitrification Line ❑ Expansion
PROPERTY LOCATION: Q kr'.
Name: (owner) C SUBDIVISION 4 Z', (r LOT # a
System Installer. c C""k Registration #
Basement with plumbing: ❑ Garage ['Number of Bedrooms
Type of Water Supply: ❑ Community E~''1'ublic ❑ Well Distance from well feet
System Type: IL Q 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.
ims 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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DCDNIT fAkInITIALIC.
1. Performance
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the se_wag"isposal system on the bove captione property.
Type of system: ❑ Conventional r! Other w V Septic Tank: 04k gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches q- of each ditch ec feet ditches _ feet ditches IS inches
French Drain Required: Linear feet
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Authorized State Agen Date 121.)-t z~~~
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