OPHTE#r -5'-ZD(,S1j Harnett County Department of Public Health 2 0 4 4 3
PERMIT # YR33 A eration Per
Z' New Installation 2-""Septic Tank ❑ Repair Liz Nitrification Line ❑ Expansion
PROPERTY LOCATION: rm ~ys~ &4,<-., ~ /M
Name: (owner) c. SUBDIVISION _,4j ,r► c~P LOT #
System Installer: Registration #
Basement with plumbing: El Garage mber of Bedrooms
Type of Water Supply: ❑ Community IJ Public ❑ Well Distance from well feet
System Type: l 01-:7-6 Gl2z)-) G 'M pes V and VI Systems expire in S years.
(In accordance with Table V a) wner must contact ealth 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.
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PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. 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 sewajrdisposal system on the above captio ed property.
Type of system: ❑ Conventional 2 Other Z-5 % lG ' 7/ Se tic Tank: d d
Subsurface No. of p gallons Pump Tank: gallons
2 exact length width of depth of
Drainage Field ditches J of each ditch _/Wfeet ditches 3 feet ditches _,?G J/9 inches
French Drain Required:
Linear feet
Authorized State
Date 3- 1 - (c)
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