OPHTE# /d -5--Zq 76-/ Harnett County Department of Public Health 21 0 6 0
PERMIT # c7C~dS 9 , Operation T/ Perit
2/ New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
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Name: (owner) SUBDIVISION _S j So~,3 LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage 2 mber of Bedrooms Z?
Type of Water Supply: ❑ Community C Public ❑ Well Dista~e irswell feet
System Type: f r c ~'/rte U~iT~~ ~ tk pes V and VI Systems expire in 5 years.
(In accordance with Table V a) (fK er must contact Health Department 6 months prior to expiration for permit renewal.
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north larolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
Permit and Construction Authorization.
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other&,pg f ~b 25~lo 17"00 0)? optic Tank: IDD a gallons Pump Tank: JoDd gallons
Subsurface No. of exact length n width of depth of
Drainage Field ditches 3 of each ditch 0* 0 feet ditches feet ditches ! 9 1?~3y inches
trench Drain Required: Linear feet
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