OPHTE#ly's- Harnett County Department of Public Health 21 0 2 2
PERMIT # 257/3 Oration PO lt
ZNew Installation L;J Septic Tank ❑ Repair ZNitri6cation Line
❑ Expansion
PROPERTY LOCATION: z
Name: (owner) f~if ~/fsa cal L669M SUBDIVISION _1~..~iE.~ S~"~►l 5 LOT #
System Installer: zf&,%r- Registration #
Basement with plumbing. ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community U Public ❑ Well Distance from well feet
System Type: ZVA Z6 60GTLA--- ;5s,s4-0 _ !4iv Bs'G LZz 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.
THIS spnem nas peen mstaneo in comp
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with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the
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nt Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
11. 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:
V. Other.
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1$°/a Z"d64- e Septic Tank: / ba D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch / CIO feet ditches 3 feet ditches Z q inrhe<
French Drain Required: Linear feet
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