OP RHTE# D4-S- ZZ- -?3/7 Harnett County Department of Public Health 2 0 9 0 5
PERMIT # Z 5VJ3 ~ /"Operation Pelt
5~ New Installation Septic Tank El Repair IJ Nitrification Line El Expansion
PROPERTY LOCATION:SC/5~~' IeA
Name: (owner) 11x SUBDIVISION G LOT # .-F
System Installer: r /Zs Registration
Basement with plumbing. ❑ Garage Vpubli( umber of Bedrooms
Type of Water Supply: ❑ Community ❑ Well D tan prom well feet
System Type: L'1o 2~r)(KYLA.~Sitl~s.. Tim C~ ~7- 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.
mis system nas Deen Instanea in
with applicable North Carolina General Statutes, Rules for
Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
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1 LI\1111 LVI1VIIIV113.
1. Performance:
II. Monitoring:
111. 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 sews disposal system on the above captioned property.
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Authorized State Date 3
Type of system: El Conventional Other Z5 °/v i7~r}f/ Sti~~rL Septic Tank: /ZtY C} gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
tart
Drainage Field ditches of each ditch feet ditches 3 feet ditches 7 inches
French Drain Re wired: Linear feet
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