OPHTE# N -S_ -3u31/ Harnett County Department of Public Health 23773
PERMIT # ?SR&2_ 0 eration Per it
CT�'New Installation Septic Tank ff"Nitrifiication Line ❑ Repair ❑ Expansion
PROPERTY L06ATION�z_/� ,00 6!��
Name: (owner) 1112 eU-_ 141e -*, SUBDIVISION LOT #
System Installer: �AScrja Registration
Basement with plumbing: [?� Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 4Pzt-A ypes V and VI"Systems expire in 5 years.
(In accordance with Table V a) Owner must 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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
�-
A
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 ❑
Following are the specifications for the seeww�ae disposal system on the above captioned property.
Type of system: El Conventional L( Other %S"/6 91'—�D06r 6` l c sf --- Septic Tank:
Subsurface No. of exact length t width of
Drainage Field ditches 2 of each ditch d �' feet ditches _
H2OLine ❑
PWR Line
/ o C' o gallons Pump Tank: gallons
depth of
3 feet ditches 22 inches
French Drain Required: Linear feet
Authorized State Agent Date x 3