PUMPHTE# Harnett County Department of Public Health 23712
PERMIT # c28 Y si Operation Permit
ENew Installation 2f Septic Tank d Nitrification Line ❑ Repair ❑ Expansior
�^ PROPERTY LOCATION: /&,,,Ar Ckua r-4, AA
Name: (owner) Cor+Tcri Nor�Cr SUBDIVISION J-4 } .tan LOT # z*?
System Installer: Pk'rLS:or l36cli Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .F
Type of Water Supply: ❑ Community ePublic ❑ Well Distance from well feet
System Type: h 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of she Improvement Permit and construction Authorization
YtKMII LONUIIIUm:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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 El
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disport s,y,s.tepm on the�^'llabove captioned Broperty
Type of system: ❑ Conventional Other &Os 1 ka is "ILT e/ C4 7.r, , Septic Tank: Ob G gallons Pump Tank: OO 0 gallons
Subsurface No. of exact length width of depth of
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Drainage Field ditches of each ditch 80 feet ditches `� feet ditches y inches
french Drain Required: Linear feet yam_
Authorized State Agel ¢ Date // 23—i�—
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