OPHTE# J� -s -34232 Harnett County Department of Public Health 23350
PERMIT # peration Perm
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
,�. PROPERTY LOCATIMN s&d /2/)
Name: (owner) �` tali e46�.4- SUBDIVISION u P LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage El )kmber of Bedrooms
Type of Water Supply: ❑ Community Zr Public ❑ Well Distance from well fee
System Type: Z,1VA 5 i it Types V and VI Sys ms expire in 5 years.
(In accordance with Table V a) ' Owner must con act Department 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 {II conditions of the
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
ij
v
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.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional ZOther 2504 A Septic Tank: // C� — n n gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch ta® feet ditches 3 feet ditches 2 `f ($ inches
French Drain Required: Linear feet
Authorized State Age�T� � +a -- Date � i 4e /
14 -5 -34232 (2)
14 -5 -34232 (3)
14 -5 -34232 (4)
14 -5 -34232 (5) 14 -5 -34232 (6)
14 -5 -34232 (7)
14 -5 -34232 (S)
14 -5 -34232 (9)
14 -5 -34232 (1)