OPHTE#Q7- '/P1SS~ Harnett County Department of Public Health 20901
PERMIT # Z YS1SI/ eration Per It
C' New Installation Septic Tank ❑ Repair LAC Nitrification Line ❑ Expansion
PROPERTY LOCATIONS,- 1y q p s ,~n s
Name: (owner) _S/if~1 / OO Ti~C SUBDIVISION ~ fi~7-~s LOT # G
System Installer: Registration #
Basement with plumbing: ❑ Garage 1~ Number of Bedrooms .3
Type of Water Supply: ❑ Community Q Public ❑ Well Distance from well feet
System Type: Z,~°h Q66yL trr_ G 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.
mu system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sena Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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URMIT rAimITIIIW
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. 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 sewAe disposal s
% tem on the above captioned propelty.6
Type of system: ❑ Conventional 2 Other 75 "7,~, /(,rkr, . Septic Tank: W ) > gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches z of each ditch 12 t7 feet ditches 3 feet ditches Z& tf~ inches
French Drain Required: Linear feet
Authorized State Aged T fhvf1~/f r Date 1- I 0
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