OPHTE# QS-S - ZZ60A~ Harnett County Department of Public Health 2 0 8 7 7
PERMIT # Z~ Y 2~f pePatloll Pert
ld New Installation L' Septic Tank
❑ Repair (d Nitrification Line F-1 Expansion
PROPERTY LO(ATION:sysoi /45/,/ aT,u,Qr gyp
Name: (owner) / Al au o SUBDIVISION i E2 LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bedrooms 3
Type of Water Supply: ❑ Community L/ Public ❑ Well Distance from well feet
System Type: ZM Ut. r2~ S _ Tye IIZ G EF!!nrr 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.
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.
& l I -5744 (.E &A - I j
PERMIT CONDITIONS: U - yo
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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewa disposals stem on the above ~c~ptioned property.
Type of system: El Conventional Other 7 /v ,ztv`m~ (j2t,s~y _ Septic Tank: DU 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch /00 feet ditches 3 feet ditches Z8 h inches
French Drain Required: Linear feet
Authorized State
Date 1-11 -o
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