OP RRRNTE#~b-a a S~i,E'•QR Harnett County Department of Public Health 19866
PERMIT # L Y1!0 0 erationn Per 6t
New installation Z Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOUITION:54lYZ5`h+'-,r.2«16-)
Name: (owner) SUBDIVISION LOT # 3
System Installer. Registration #
Basement with plumbing. ❑ Garage ❑ )Wmber of Bedrooms 3101-
Type of Water Supply: ❑ Community 0 Public ❑ Well Distance from well feet
System Type: Z4116 (L61?cJCAWL._.!5.c - 2.~ G BZ Types V and VI Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has ben installed in compkance with
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North (uoHna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the improvement Permit and (omtsuaion Auttroriution,
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Y. Other.
Following are the specifications for the sews disposal system on the above cap oned property.
Type of system: ❑ Conventional li~ Other 2So V Size of tank: Septic Tank: 10 0 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch _3Dp feet ditches -3' feet ditches inches
French Drain Required: Linear feet
Authorized State A Date 3 `~-b~