OP RHTE#0-5--Z31„/1' Harnett County Department of Public Health 21 0 3 7
PERMIT # Z~ S 0 eration Pe ot
New Installation Setic Tank ❑ Repair /Nithication
Line ❑ Expansion
PROPERTY LOCATION: ~.i IVS7 W r✓1 &y,,,,, Ai>
Name: (owner) / n,,, ~ Jz„L Tit SUBDIVISION LOT # .Z
System Installer. Dom,, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community L~ Public ❑ Well Distance from well fee
System Type: r Z L Z$~/o R4, 6 - Types .
(In accordance with Table a yst ms expire in 5 years.
Owner must contact Health rtment months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewa eatment and Disposal, and II conditions of the Improvement Pennit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 seewws disposal system on the above captioned property.
Type of system: ❑ Conventional Other z j W r T ta tr 4 Zt l Septic Tank: 10 6 6
Subsurface No. of V gallons Pump Tank: gallons
exact length width of
Drainage Field ditches 3 of each ditch / o G feet ditches 3
French Drain Required: Linear feet feet depth of
es L8 7y inches
Authorized State Agen,~,a,~ ~~~•+s
Date 6 - Z3 -1 p
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