OPHTE# 0'1-'S - lBtabR sl+~~ Harnett County Department of Public Health 19837
PERMIT # Z iqo 0 eration Per It
Id New Installation Z Septic Tank 0 Repair LiJ Nitrification line 0 Expansion
PROPERTY LOCATION M/5 z 0/!~_~idreS cTC~ic~zJ~
Name: (owner) C lzi-5 fAV 4;o 4, SUBDIVISION LOT # 3
System Installer. Registration #
Basement with plumbing. ❑ Garage umber of Bedrooms
Type of Water Supply: 11 Community I Public ❑ Well Distance from well feet
System Type: 15%9tcbuc,pn l ~a4.rT~~G el -*I Types Y and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This srstern has been mstaW in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Mproremerw Permit and [onstnution Aushorizauoo.
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1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
Y. 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.
following are the specifications for the s disposal system on the above captioned property.
Type of system: El Conventional ewaOther ~o Gi f~ Size of tank: Septic Tank: /0 0 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch _5b _ feet ditches 3 feet ditches 24 inches
French Drain Required: Linear feet
Authorized State Ant 9~G ~,4,,✓`i/h-t_7 Date f - 9-06