OPHTE# 09-S"- 20R.: Harnett County Department of Public Health 2 0 4 5 4
PERMIT # ZVg11 Operation P It
[New Installation Septic Tank ❑ Repair /Nitrification Line ❑ Exnansion
PROPERTY LOCATION: /6 t~- SPA-"
Name: (owner) f ie^.;At4 RcA)czl SUBDIVISION 04Wi° S!A LOT # Z7
System Installer: T`f 1>6 &4111, Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 3
Type of Water Supply: ❑ Community r public El Well Distance from well feet
System Type: imG 2z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner ust contact Health Department 6 months prior to expiration for permit renewal.
This system has heen installed in compliance with applicable Nob Carolma General Statutes'hies for Sewage Treatment and
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
and all conditions of the Improvement Permit and Construction Authorization.
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 ,4e disposal system on the above captioned property.
Type of system: ❑ Conventional Other 7 S 'lb fV- ' cT- t,i J Septic Tank: { o~ o gallons Pump Tank: gallons
Subsurface No. of exact length width of -3 depth of
Drainage Field ditches of each ditch ab feet ditches feet ditches 7- lo--) 419 inches
French Drain Required: Linear feet
Authorized State Ag Date S'-20 -6 1
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