OPHTE# Oa-5•aao-1`} Harnett County Department of Public Health 2 0 8 0 2
PERMIT # a51-1`3 6 elation Permit
New Installation IN Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: Tt N
Name: (owner) W~s-« Co . QQ . ~,-,4 c- SUBDIVISION SaMFS Q~eFt~~6N LOT # ' 1
System Installer: ~cfl 'iL>aovqrj Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t bb 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 oeen mstaneo in compliance with applicable North Larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ] Other Q v -n Li C~,k Nne r-- y Septic Tank: \ bd c7 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ~I of each ditch 3O 0 feet ditches 3 feet ditches QJi -3,(7) inches
French Drain Required: , ~:~m , feet
Authorized State Agent Q-~ Date
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