OPHTE# L7 "r" I Harnett County Department of Public Health 19609
PERMIT # v2 q t a Oaeration Permit
E'New Installation C2Septic Tank ❑ Repair E Nitrification Line ❑ Expansion
PROPERTY LOCATION: S/L 14 S".)-
Name: (owner) l0t4 - r- SUBDIVISION -,S-- n --q. - S ; - g LOT #
System Installer. &clc A~e ct Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community B"' Public ❑ Well Distance from well feet
System Type: Ti? C- Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
inns system nas oeen instawo in
with "cahk North larohna ben" Statutes, Rules for Sewage Treatment and Disposal and all conditions of fie improvement Permit and Construction kudroriraUon.
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PERMIT CONDITIONS:
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1. rertormance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
111. 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.
Following are the specifications for the sews sposa! system on, the above captioned property.
Type of system: ❑ Conventional Other 2 G c: tl~ Size of tank: Septic Tank: 0 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch 0 feet ditches J feet ditches 16 inches
rem ram Required: linear feet
Authorized State Agen
d.w ( Date Sao
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