OP RHTE# Uri -S - z51P'FIz Harnett County Department of Public Health 2 0 9 0 2
PERMIT # 25.762. Operation Pe lt
New Installation L_SI Septic Tank El Repair Ntrificati
on Line ❑ Exoanstnn
PROPERTY LOCATION:.-j~ 1.:5-s-3 Gcvc a~~ /2i)
Name: (owner) C~ ~,~,1<~, ~Z¢~J SUBDIVISION ss 6,-66 LOT #
System Installer: C X Registration #
Basement with plumbing: ❑ Garage 'tuber of Bedrooms 3
Type of Water Supply: ❑ Community Ld Public ❑ Well Distance from well feet
System Type: Z5-0/- R-1-b AU4 3 " 6Z ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contac Health Department 6 months prior to expiration for permit renewal.
um system nas Dee" mstaueo in compliance with
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North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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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:
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: El Conventional Other ~h~cTtc~ c~L Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches _ of each ditch feet ditches 13 _ feet ditches 2 inches
french Drain Required: Linear feet
Authorized State Age c Da - Z-3-