OPHTE# 3s-26�, Harnett County Department of Public Health 23583
PERMIT #Zg2 /0 erp ation Per t ��
Z New Installation Septic Tank E3 /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATIM-�51u:7 lZ4. --s L/ice 1/3 96
Name: (owner) SUBDIVISIONLOT # Is—
System Installer: Registration #
Basement with plumbing: ❑ Garage ��umber of Bedrooms �_
Type of Water Supply: ❑ Community LST Public ❑ Well Distance from well feet
System Type: 1596' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Own�musto actHealth 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 Lonstruction Autnorization.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other:
❑
D -Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the
specifications for the sewage disposal system on the above captioned property.
Type of system:
El Conventional E2 tither 25%
2A-DUA'4-�
Septic Tank: 10 0 Ci gallons Pump Tank: gallons
Subsurface
No. of
ditches �_
exact length 1
of each ditch 80 feet
width of depth of
ditches feet ditches ZL4 "7 f inches
Drainage Field
French Drain Required: Linear feet
Authorized State Age �--.. Date
15-5-35266 (1)
15-5-35266 (2)
15-5-35266 (3)
15-5-35266 (4)
15-5-35266 (5)
15-5-35266 (6)
15-5-35266 (7)
15-5-35266 (11) 15-5-35266 (12)
15-5-35266 (8)
15-5-35266 (9)
15-5-35266 (10)