OPHTE# Is—b ) Li Harnett County Department of Public Health 23809
PERMIT #%83._7._ /Operation Per 't
LAS New Installation Septic Tank Cd' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: zxjw3 C kashaa. /Z6
Name: (owner) afh ObCx SUBDIVISION LOT #
System Installer: _ uAir Registration #
Basement with plumbing: ❑ Garage N mber of Bedrooms 3rD «'0
Type of Water Supply: 11, CommunityPublic ❑ Well Distance from well feet
System Type: 2 Gd�"�pes-Wand VI Systems expire in S years.
(In accordance with Table V a) % Owner must contact Health Depantrvd months prior to expiration for permit renewal.
This inters has been installed in comnlianee with awliable North fneln2lGf iteral statutes. Rules for Sewaee Treatment and Diabhal. and all conditions of the Imororement Permit and (onsemttion Authorization.
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
LCT
b -A7 &41'
'3 > 1103 C.) ka. bn /4�
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Et Other 25� ,— Septic Tank: I pO 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch 8a feet ditches 3 feet ditches Zxl 519 inches
French Drain Required: Linear feet
Authorized State Ag It . n -2: N�itn,�i 2�L�' Date 10 —1 b —1 S
15-5-35869 (1) 15-5-35869 (2) 15-535869 (3)
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15-5-35869 (4)
15-5-35869 (5)
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