OPHTE#10 -S - ZyZSj? Harnett County Department of Public Health 21 0 5 6
PERMIT # Z b b 7 6 D~eratlon N It
L~ New Installation L~ Septic Tank ❑ Repair 2 /"'Nitrification tine ❑
Expansion
PROPERTY LOCATION:
/yiz C~ S<zti. J
Name: (owner) SUBDIVISION j
System Installer. LOT # _27_
Registration #
Basement with plumbing: ❑ arage Number of Bedrooms -3
Type of Water Supply: ❑ Community [Public ❑ Well Distance from well
System Type: feet
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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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 spec' cations for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface Septic Tank: / 006 gallons Pump Tank: gallons
No. of exact length
Drainage field width of ditches depth of
of each ditch 70 feet ditches feet ditches l-`f
French Drain Required: Linear feet inches
Authorized State y;
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