OPHTE# /7-- -2O ® Harnett County Department of Public Health
PERMIT # 26$29 Operation ~Peerm~it 2 2 2 8 3
E; New Installation I~ Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ 04- "
Name: (owner) 1 1 ti- c- SUBDIVISION _ i'7- LOT #
System Installer: _ Registration #
Basement with plumbing: ❑ Garage Y umber of Bedrooms -3
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: G sue- T d f hypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mkt conttaac Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statute, Rules for Sewage lR2atat~nt and Disposal, and all conditions of the
mprovement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
111. Maintenance:
IV. Operation:
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.
Other:
V
.
❑
D-Box ❑
Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system:
❑ Conventional l
Other 7%"Io XINIcAW 56 ?dn
Septic Tank: -100 b gallons Pump Tank: _ gallons
Subsurface
No. of
exact length
width of depth of
Drainage field
ditches
of each ditch feet
ditches 3 feet ditches 19 inches
French Drain Required: linear feet
Authorized State Ag t -~2 Date G 1
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12-5-28431 (1)
12-5-28431 (2)
12-5-28431 (3)
12-5-28431 (4)
12-5-28431 (5)
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12-5-28431 (6)
12-5-28431 (7)
12-5-28431 (8)
12-5-28431 (9)
12-5-28431 (10)
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12-5-28431(11)
12-5-28431(12)
12-5-28431(13)
12-5-28431(14)
12-5-28431(15)
12-5-28431 (16)
12-5-28431 (17)
12-5-28431 (4)
12-5-28431 (5)
12-5-28431 (6)
12-5-28431 (7) 12-5-28431 (8)
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12-5-28431(9)
12-5-28431 (10)
12-5-28431(11)
12-5-28431(12) 12-5-28431(13)
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12-5-28431 (14)
12-5-28431 (15)
12-5-28431 (16)
12-5-28431 (17)