OPHTE# ZSq Harnett County Department of Public Health 21058
PERMIT # Z C, d_
eration Per
New Installation Septic Tank El Repair C3' Nitrification Line ❑ Expansion
hE~i^-P PROPERTY LOCATION:-Jyr/yiZ -
Name: owner -s SUBDIVISION
System Installer: xy.,~, a LOT #
Registration #
Basement with plumbing: u ' Garage D' Number of Bedrooms
Type of Water Supply: ❑ Community F~l Public ❑ Well Distance from well
System Type: C~" feet
Sy accordance with Table V a} Types V and VI Systems expire in 5 years.
(In 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.
- Ifs
PERMIT CONDITIONS:
I. 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 ❑
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the SP cations for the sewage disposal system on the above captioned property.
Type of system: ❑ Other
Subsurface No. of exact length Septic Tank: v gallons Pump Tank: gallons
Drainage field ditches width of
of each ditch ypo feet depth of
french Drain Required: Linear feet ditches _ _ feet ditches --~O 'I (t, inches
Authorized State Agei Z211 Date _I-
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