OPHTE #, ? -5 --303'i ) Harnett County Department of Public Health
PERMIT # �� ft eration Permit 22648
'X New Installation Septic Tank Nitrification Line 1:1 Repair ❑ Expansion
PROPERTY LOCATION: ccf,
Name: (owner) \rl r4 �¢�oCS16 SUBDIVISION' 2v '� — >oGC LOT # 13
System Installer: \--v o 7, a34 L-v c lea Registration #
Basement with plumbing: ❑ Garage 1 Number of Bedrooms
Type of Water Supply: ❑ Community' Public ❑ Well Distance from well , feet
System Type: > 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 nas peen mstauea in compuance with apphcaoe north [aroma uenerat xatutes, nines tar sewage treatment and msposal, and all conditions of the Improvement Permit and Construction Authorization.
rtKMII LUNIVIIIUM:
I. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface
Drainage Field ditches
French Drain Reauired:
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage dispos I system on the above captioned property.
Other V'vOP t o - a..t�w Septic Tank: >�C Q gallons Pump Tank: loco
gallons
exact length width of depth of
cr1 of each ditch feet ditches feet ditches , inches
XX Authorized State Agent N�� �5 Date N-30