OPIITE# G 7 s- I1~ 05 Z Harnett County Department of Public Health 19860
PERMIT # t2i y. U d eration Per i-t
New Installation C3 Septic Tank ❑ Repair LZ Nitrification line ❑ Expansion
PROPERTY LOCATION:L, y ,Tff a{~/z
Name: (owner) L Z K / / 6 - J - 5 ~ , Elf-/mss SUBDIVISION Q u-s: , s LOT # z5
System Installer. z14) Cl-- Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 2
Type of Water Supply: ❑ Community tJ Public ❑ Well Distance from well feet
System Type: ZS% Due-+ti-)-) rc~/J._T,/1rt /L/71 /-Z "k, Types V and VI Systems expire in S years. -vs
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
this system has been mstaged in comphaxe with applicable North Carolina General Statutes, Rules la Sewage Treatment and Disposal, and al conditiom of dw Improve-t Permit and Construction kthoriratiom
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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. 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 seewwX disposal system on the above captioned property.
Type of system: ❑ Conventional Ld Other .20~ 17,-(-'PUGrimJ 5.,~rlfh Size of tank: Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch I b D feet ditches 3 feet ditches /L Z inches
French Drain Required: Linear feet
Authorized State Date 7_ -11 -03