1676 NC 55HTE# 0-7-5-- I'7i*W)&, Z., Harnett County Department of Public Health 20451
PERMIT # 0 erah n Pe lt
I /New Installation Ld Septic Tank El Repair 5 Nitrification Line F-1 Expansion
PROPERTY LOCATION: 5s"
Name: (owner) SUBDIVISION LOT # / - ye, System Installer. Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms .S
Type of Water Supply: El Community Public ❑ Well Distance from well feet
System Type: LAS '/a ~1CJU2 n 3 ,g.,,~ T ~ G 62(,9+y 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.
Inis 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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L Performance:
11. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
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.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other 45% aploenff~3 Septic Tank: 4 ozr?~)_ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch _7 7 0 feet ditches feet ditches Zinches
French Drain Required: Linear feet T
Authorized State Agen Date S'~3 ~9
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