OPHTE# /o-s - 2'/ y~~ Harnett County Department of Public Health 21 0 5 5
PERMIT # .Z wbw`A Operation _Pe it
2( New Installation L✓1 Septic Tank ❑ Repair d Nitrification Line ❑ Expansion
PROPERTY LOCATION:s7t/"/4?
Name: (owner)
SUBDIVISION ~..v~ LOT # 6
System Installer. 45e->a ' Registration
Basement with plumbing: ❑ Garage kmber of Bedrooms
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: °/n DUCT ZoI) fir,,, Z7i'G - ~z~jQ~~ 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 age Treatment and Disposal, an I conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. 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 sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other 2SaG a-b o u2c,J (gyp 4--KA} Septic Tank: t Zan gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch SD feet ditches .3 feet ditches IR inches
French Drain Required: linear feet
Authorized State A 2 ~A-1~
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