OPHTE# iz-Harnett County Department of Public Health 24045
PERMIT # / Operation Permit
Q New Installation ID Septic Tank Nitrification Line ❑ Repair ❑ Expansion
%�� � �J PROPERTY LOCATION: b2 U/5" //ia/ul 7rC o iZZ
Name: (owner) Z/UfY(�F-elata-d SUBDIVISION a4 4 TjL /- , Al LOT # Z6
System Installer. _ihrt5,I fit registration #
Basement with plumbing: ❑ Garage f umber of Bedrooms
Type of Water Supply: El Community Public ❑ Well Distance from well feet
System Type: 2 o r2 'r e16�, fJ�— .aaLTypes Vand VI Systems expire in S years.
(In accordance with Table V a) T �� Owner must con ac 'alth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General statures, Rules for sewage Treatment and disposal, and all conditions of the Improvement Permit and lnmMCtIon Allmonunon.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 sew�Ba disposal system on the above captioned property.
Type of system: El Conventional 13 Other 75 % AOX ( L"jycf Septic Tank: / L 0 o gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch Z° ° feet ditches 3 feet ditches Z�'� f 8 inches
French Drain Required: linear feet
Authorized State ALO 1�"`""'� �, Date "� y�
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16-5-37845 (1) 16-5-37845 (2) 16-5-37845 (3) 16-5-37845 (4) 16-5-37845 (5)
16-5-37845 (6) 16-5-37845 (7) 16-5-37845 (8) 16-5-37845 (9) 16-5-37845 (10)
16-5-37845 (11) 16-5-37845 (12) 16-5-37845 (13) 16-5-37845 (14) 16-5-37845 (15)
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16-5-37845 (16) 16-5-37845 (17) 16-5-37845 (18) 16-5-37845 (19) 16-5-37845 (20)
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