OPHTE# -S= {5"~ Harnett County Department of Public Health 19846
PERMIT # Z 333 0 eration Per t
Ia New Installation fa Septic Tank ❑ Repair B" Nitrification Line ❑ Expansion
PROPERTY LOCATION: y6~ A
Name: (owner) L?i~.~~ D l-J SUBDIVISION LOT # e~_
System Installer A&ec C',v rzd,Qp Registration #
Basement with plumbing ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: zza G a z 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.
tres system nas been inMW in compliance with applicable North Carolina General Statutes, Rules la Sewage ireatmens and Disposal, and all conditions of the hnproresnent Perstdt and construction IsW'61 t M
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PERMIT CONDfTIONS:
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 sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z:j7& /W4DW--7?4;)) Size of tank: Septic Tank: !b b O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of gallons
Drainage field ditches of each ditch feet ditches 3 feet ditches Z q inches
French Drain Required: Unear feet
Authorized State
Date I - Z5-0 8