OPHTE#r—'i5--3684r Harnett County Department of Public Health 23875
XV4b
PERMIT # Zt494 Operation Permit
New Installation Septic Tank 2Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: IW v2
Name: (owner) 171KC /itS&M S SUBDIVISION AK J64_J Fav n..+ --g LOT # S
System Installer: C4adtaa/FS (.w.,yta.c Registration #
Basement with plumbing. ❑ Garage IrNumber of Bedrooms 3
Type of Water Supply: ❑ Community E?� Public ❑ Well Distance from well feet
System Type: 1'S% VAb u Ly— arJ 5 ft;_ G �Os,Y and VI Systems expire in S years.
(In accordance with Table V a) Owner�o�artment 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nonh (amlina General Stammer, 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:
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27 rZ
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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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewafF disposal system on the above captioned property.
Type of system: ❑ Conventional I� Other 15":. Septic Tank: 00 O gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch lop feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent�a.--�-� xs/� //�a.lh �vYl�� Date /z —/7 — / 5—
15-5-36845 (1)
15-5-36845 (6)
15-5-36845 (2)
15-5-36845 (3)
a
15-5-36845 (4) 15-5-36845 (5)
15-5-36845 (7)
15-5-36845 (8)
15-5-36845 (9)