OPHTE#-' ~4 -,5=9 Harnett County Department of Public Health
PERMIT # z608 0 ep ration Pe it 21 7 0 5
Z/New Installation G?c Tank Nitrification Line 1:1 Repair
P ❑ Expansion
PROPERTY LOCATION:yG/S"Go „
Name: (owner) &tzg. zo -V--r- SUBDIVISION A65Kr-'c= X045-5- LOT #
System Installer: a r-x 56 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms)
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1572~j 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.
'wJLf ~l~ r~,rc r'
C
110
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961. '51L
1J~D ~S~jjS AZT
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned pro erty ,
Type of system: ❑ Conventional Other Z5")/o ..I)UC11d?~ ~-tl i Septic Tank: /D® 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 00 feet ditches feet ditches ZW inches
French Drain Required: Linear feet
Authorized State A ent Date I2 JS J V