OPHTE# oci -,5'=a 1-~S-C Harnett County Department of Public Health 21 13 0
PERMIT # 0 eratian Per
~Ne-w Installation Septic Tank El Repair-tINitrification Line ❑ Expansion
PROPERTY LOCATION: N1;
Name: (owner)- n.~.c, l Ids SUBDIVISION 'f Pd: . LOT # 1j,.7
System Installer: c: I J1-, /tai Registration #
Basement with plumbing: ❑ Garage Humber of Bedrooms
Type of Water Supply: ❑ Community E~Public ❑ Well Distance from well
System Type: _ ~ feet
Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most 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.
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PERMIT CONDITIONS:
I. Performance:
If. 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
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the seewwa disposal system on the, above captioned property.
Type of system: ❑ Conventional IQ Other f%Z F(o
Septic Tank: d6 gallons Pump Tank:
gallons
Subsurface No. of ~ exact length width of depth of
Drainage Field ditches of each ditch ~d feet ditches 30
French Drain Required: feet ditches inches
linear feet
Authorized State Age
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