OPHTE #� - 32qj5' Harnett County Department of Public Health 23203
PERMIT # Z, -7 MIT 0 erat°ion Pe mit
5 New Installation Septic Tank VNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:, /�T l , oe iz,
Name: (owner) 6 - ,r.' SUBDIVISION /,c U & ;r uief LOT # 3
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community V1 Public ❑ Well Distance from well feet
System Type: " ' `Z ` —7 — 66? V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact He th Department 6 months prior to expiration for permit renewal.
This system has been installed in
nrnu�r rnuninnuc
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
with applicable North Ca olina General Statutes, Rules for Sewage Treatment and
and all
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.
M
Hof the Improvement Permit and Construction Authorization.
'tea
IW�
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the seewwap disposal system on the above captioned property.
Type of system: El Conventional L� Other ZiF L4 -- Septic Tank: I gallons Pump Tank: gallons
Subsurface No. of exact length, width of depth of
Drainage Field ditches of each ditch tS feet ditches -3 feet ditches y �` inches
French Drain Required: Linear feet
Authorized State A6,nt— •-- s� z-~ °' Date "
1
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