OPHTE#o~-5 ~ZZ 3,3 Harnett County Department of Public Health 20881
PERMIT # Z'5_41 0 eration Permit
L/I New Installation LQ Septic Tank ❑ Repair Z'J Nitrification Line ❑ Expansion
PROPERTY LOCATION:2L/y-qp le-0
Name: (owner) Scott 4 A-c r-ss-,a K
< 11 SUBDIVISION 714:p,_ LOT #
System Installer: .pa-u (=ft >a y 64bo y %Pr?c Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply, ❑ Community U Public ❑ Well Distance from well feet
System Type: _ 7_-T4a Types V and VI-Systems expire in 5 years.
(In accordance with Table V a) Owner must contact H9 th Department 6/months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rukes for Sewage eatment and
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
and conditions of the Improvement Permit and Construction Authorization.
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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 s disposal stem on the above captioned property.
Type of system: El Conventional ewaOther 1 ~ C ~°5 Septic Tank: 17-00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches -3 feet ditches Z6 -I inches
French Drain Required: _ Linear feet
Authorized State Agi3-r~~gl Date z 2.23
FROM DON GADDY
SEPTIC TANK CO.
PHONE NO.
9102451038
Sep. 23 2009 05:47PM P1
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