OPHTE# ► 3 _; = 3��- Harnett County Department of Public Health 23184
PERMIT # Z l�Z o l perabon Per
New Installation P Se tic Tank 2/Nit �
fcation Line ❑ Repair ❑ Ex ansior
PROPERTY LOCATION: ;V / go (�7, o in s�
Name: (owner) 13o k e.t SUBDIVISION -j . ! LOT # I_
System Installer: 1- " 94v c LtIIM4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of�Berod
Type of Water Supply: El Community El Public 2 Well Distance from well / t-t feet
System Type: Z5 � YsT � 't � ystems expire in 5 years.
(In accordance with Table V a) wrier must contact Health Department 6 months prior to expiration for permit renewal.
r-
This system has been installedlin compliance with applicable North Carolina General Statutes, Rules for SewaRe Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
Ill. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewaa isposal system on the above captioned property.
Type of system: ❑ Conventional L'_f Other{''--" Septic Tank: Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch / 7th feet ditches 3 feet ditches Z4 inches
French Drain Required: Linear feet
Authorized State A Date 1 " i
13 -5- 32459(1)
13 -5 -32459 (2)
13 -5 -32459 (3)
13 -5 -32459 (4)
13 -5 -32459 (5)
13 -5 -32459 (6)
13 -5 -32459 (11)
13 -5 -32459 (7)
13 -5 -32459 (8)
13 -5 -32459 (9)
13 -5 -32459 (10)