OPHTE# p--)-s - I6rp6-4- Harnett County Department of Public Health 21 0 2 6
PERMIT # Z3-7 Y5 0 eration Pe It
New Installation E Septic Tank F-1 Repair U Nitrification Line
❑ Expansion
PROPERTY LOCATION:3,c /q'/&
Name: (owner) d In. Deal ax2,X, SUBDIVISION 4,A,,._ _
LOT # z-z
System Installer: SnH^) Cx,/ Registration #
Basement with plumbing: ❑ Garage Z "Number of Bedrooms
Type of Water Supply: ❑ Community 12"Public ❑ Well Distance from well feet
System Type: 5"7o 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.
mu synem nas Deen instaneo in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
and A conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other.
Following are the specifications for the seewwsdisposal system on the above captioned property.
Type of system: [I Conventional L►1 Other ZIL,, )20001tm_ Septic Tank: f DD 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch C5 C) feet ditches 3 feet ditches Z ~u inrhpc
french Drain Required: Linear feet
Authorized State A Date `I- IG~ I1)
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