OPHTE# S 5Z'rl Harnett County Department of Public Health 23808
PERMIT # Zig3fice �Operation Permit
D'New Installation�7"Septi
c Tank 2" Nitrification Line ❑ Repair ❑Expansion
PROPERTYLO(ATION-Z2L 2474
Name: (owner) SUBDIVISION Q# m4, � A 52 ' LOT #
System Installer. FJ USS Registration #
Basement with plumbing: ❑ Garage EIr Number of Bedrooms 3
Type of Water Supply: ❑ Community [e Public ❑ Well Distance from well feet
System Type: 759 t ;q�! 6 es Vnd VI SS stems expire in S years.
(In accordance with Table V a) Owner SiRffetR 6Ymonths prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina rieneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
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 ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional POther25°/6 LV"WL, Septic Tank /00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of I
Drainage Field ditches / of each ditch 300 feet ditches 3 feet ditches ZY inches
French Drain Required: linear feet
Authorized State A¢�-a e�-7— Date 10 —1 T — 15"
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15-5-36271 (1) 15-5-36271 (2) 15-5-36271 (3) 15-5-36271 (4)
15-5-36271 (6)
15-5-36271 (7) 15-5-36271 (8)
15-5-36271 (9)
IA
15-5-36271(5)
15-5-36271 (10)