OP RRHTE# I I # 5- A03-A&
Harnett County
Department of
Public Health
PERMIT # Ze1g3
1 Ofteration P mit
IvI New Installation V Sentic Tank /Nitrification Line
21733
❑ Repair ❑ Expansion
PROPERTY LOCATION J~&e
Name: (owner) SUBDIVISION' LOT # I_
System Installer: 77dc_kv lk% I Registration #
Basement with plumbing: ❑ Garage lumber of Be ooms
Type of Water Supply: ❑ Community IJ Public Well Distance from well 1c feet
System Type: Z``°I ~ ~ZR Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must cont ct Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carol TGene al Statutes, Rules for Se age Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
PERMIT CONDITIONS:
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.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: El Conventional Other il9UCZa 1 Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3 DO feet ditches feet ditches to inches
French Drain Required: Linear teet
Date ° ii
Authorized State Agents-