OPHTE# 4-- 433,5'8 Harnett County Department of Public Health 23480
PERMIT # ZZ Sf"�f �o eration Per
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Nit Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONso 193:2
Name: (owner) Z � SUBDIVISION LOT # I:T_
System Installer: Si",,hjcr-t 0z�11)az.5 Registration #
Basement with plumbing: ❑ Garage "mber of Bedrooms -3
Type of Water Supply: El Community Ld Public ❑ Well Distance from well feet
System Type: St's ( %Zwn. 2— 6 �ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta&I- lealth 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 g4esal, a con coons o the Improvement Permit and Construction Authorization
PUM11 LUNDHIM:
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the seewwa� disposal system on the above captioned property.
Type of system: ❑ Conventional L?" Other Z5-% 12el) U&Mry5 ,- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ! of each ditch Z y a feet ditches 3 feet ditches )� inches
French Drain Required: Linear feet
Authorized State en �- 1- Date
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