OPH T E # ; Harnett County Department of Public Health
PERMIT # eration Per t 2 2 0 5 5
New Installation Se tic Tank ZNitrification Line ❑ Repair E:1 Expansion
P
PROPERTY LOCATIO t/ ` 7 ,1°Y , - a m 0, 0
Name: (owner) Kch-) t y~~ l Air,. &C SUBDIVISION LOT #
System Installer: X""' Registration #
Basement with plumbing: ❑ Garage ~ ber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: s t'' !5fc-117 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must ontact Health Department 6 months prior to expiration for permit renewal.
This 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
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 sew p disposal system on the above captioned properrX Oi
Type of system: ❑ Conventional Other `G k~ y~ Se is Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditches feet ditches feet ditches inches
French Drain Reauired: Linear feet
Authorized State AK -17-~ ( Date ° 7--7 - It
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11-5-26669(11)
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