OPHTE #_[t- 'i;_- zSZ4� L, Harnett County Department of Public Health
PERMIT # Z4=94 3 0 eration Perot / 22459
New Installation a Septic Tank C7 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3WC ? ?r S- 4&r .
Name: (owner) r9rt6�AA SUBDIVISION Q,,1 btS,) LOT # 3
System Installer: .:fi Registration #
Basement with plumbing: ❑ Garage ! Number of Bedrooms 4
Type of Water Supply: El Community 1� Public ❑ Well Distance from well feet
System Type: 49Z Types V and VI Systems expire in 5 years.
(In accordance withXble VOA Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has bWnstall14'ig/compliance with applicable North Cd General Si
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
Ir
for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
,s _e ff--1 III'
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the s disposal system on the above captioned property.
Type of system: El Conventional ewa Other Zs'"�ot�uG s �-r� _ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch fV feet ditches 3 feet ditches inches
French Drain Reauired: Linear feet
Authorized State en 2, 1 Date 9 Z°1 — I Z