OPHTE# C8 - S-Zz9 59 Harnett County Department of Public Health 2 0 8 9 5
PERMIT # Z T3 / 0 eratlon Permit
New Installation Rf Septic Tank ❑ Repair 2 (Nitrification Line ❑ Exnansinn
Name: (owner) <f14c1r5 T PROPERTY LOCATION: .yu sw 106/j ,zJ
~'ov k~y SUBDIVISION GEE .c rAdruc rv;} LOT #
System Installer: 4~tsd-.r /*I* Registration #
Basement with plumbing: El Garage /Number of Bedrooms
Type of Water Supply: 11 Community ;Public ❑ Well Distance from well feet
System Type: z Mo T G eZ 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.
...u ipam u~ ueen maauea in
with apptucahle north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z5% 1V-60GT Septic Tank: 100 d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch IoC3 feet ditches 3 feet ditches 2`>i inrhat
rent ram Required: Linear feet
Authorized State A g Date -Iq-ID
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