OPHTE# Zl=-= Harnett County Department of Public Health 2 0 4 3 7
PERMIT # zs~/z Operation Flewt
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
Name: (owner) * 14eA44,. 64,r .1
System Installer. ' A
Basement with plumbing: ❑ /Garage umber of Bedrooms
Type of Water Supply: ❑ Community VPublic ❑ Well
System Type: 153o P~c~ttnJ 7-1 e
6
(In accordance with Table Vth Table V a)
PROPERTY LOCATION: sc~Y,a rLy
SUBDIVISION . i f LOT #
Registration #
Distance from well feet
E'L4 Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior piratioNor permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all loons of the Improvement Permit 4d Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
If. 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 sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z54 IMbp Septic Tank: ) D b O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch 8D feet ditches 3 feet ditches z~ ~y t d" inches
French Drain Required: Linear feet
Authorized State Age ,tah,-►t f o Date 3 , 24-0
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