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PERMIT # Z " 6 /
Name: (owner) v1.
System Installer: k~Y
Basement with plumbing. ❑
Type of Water Supply: ❑ Co
System Type: Z
(In accordance with Table V a)
~G Types V and VI Systems a pire in 5 years.
Owner must con ct Health Department s rior to expiration for permit renewal.
Thu system has been installed in compliance with applicable North Carolina Gene Statutes, Rules for Sewage Treatment and Disposal, and all con tions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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 tsposal system on the above captioned property~tic Type of system: ❑ Conventional Other a~ J .M Tank: /00<)
gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch g O feet ditches feet ditches ZI -y79 inches
French Drain Required: Linear feet
[Authorized State Age ez,
Date ll--
Harnett County Department of Public Health 21 0 4 8
peration Pe It
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: spa
_ SUBDIVISION .T~-..i? _LOT # 3
Registration # _
Garage ❑ umber of Bedrooms -3
- unity L Public ❑ We I Distance from well feet
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