OPHTE #Iq 53&z3 Harnett County Department of Public Health
23341
PERMIT # Z -7974 ' Operation Pie r t
'
I � New Installation c Tank L!1 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,5)LJ 4311 tfAIN`-- 4JJ
Name: (owner) G� ,R.6hw' i � o SUBDIVISION LOT # 4
System Installer: sr— Registration #
Basement with plumbing: ❑ Garage ZNumber of Bedrooms 3
Type of Water Supply: ❑ Community ZIPublic ❑ Well Distance from well feet
System Type: d-a 27M pes V and VI Systems expire in 5 years.
(In accordance with The V a) I Owner At contact Health 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.
u—
PERMIT CONDITIONS: S�
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑
Pump ❑ Alarm
❑ H2O1-ine ❑ PWR Line
Following are the
specifications for the sewage disposal
system on the above captioned property.
Type of system:
❑ Conventional Q"—Other ��
L-a 25-% ��
Septic Tank: I gallons Pump Tank. ° " c) O gallons
Subsurface
No. of
exact length
width of depth of
3
Drainage Field
ditches
of each ditch 33D feet
ditches feet ditches 21y inches
French Drain Required: Linear feet
Authorized State Agen Date