OPHTE# 6~-J-- zZ,-7L7 Harnett County Department of Public Health 21 3 0 7
PERMIT 0 eration Per
~ew Installation SeePttic Tank El Repair fl Nitrification Line ❑ Expansion
PROPERTY LKATION: /Ar.r'z' T-1,11,1_41,
Name: (owner) / t`ad~a,1 ~u:Et SUBDIVISION XA-V-~1 Aa,J LOT # Iq
System Installer. Sc,( Registration #
Basement with plumbing. ❑ Garage Nu ber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 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 system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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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:
V. Other.
Following are the specifications for the se_w5e disposal system on the~bove captioned property.
Type of system: ❑ Conventional f~l Other F-2--~/cc-.7 Septic Tank: h~ a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches ~ -1-5 inches
french Drain Required: Linear feet
Authorized State Ave er• CL' Date =ZJ-c/
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