OPHTE #/d- S-3$oz-1 Harnett County Department of Public Health 24054
PERMIT # ZS700 0 eration Permit
New Installation Septic Tank C7 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION•kk ivvda ljrx t ,0'�
Name: (owner) FbL.a/ DAkS Syrc r� 6_4021. SUBDIVISION /4-rtcsJ 2, ✓Ll f.—. s LOT # S
System Installer: Medlr -, Registration #
Basement with plumbing: ❑ Garage 19 Number of Bedrooms 4
Type of Water Supply: ❑ Community W Public ❑ Well Distance from well feet
System Type: t G Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner mks con a Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with appliable xonh Carolina General Statutes, Rules for Sewage Treatment andDisposal, and all conditions of the Improvement Permit and Consrmsuon Authoritarian
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sew�$e disposal system on the above captioned property.
Type of system: El Conventional f�Z Other Z�/drliEU>r t+rrSeptic Tank- gallons Pump Tank
Subsurface No. of exact length width of depth of
Drainage field ditches .3 of each ditch /dD feet ditches 3 feet ditches 12'r
French Drain Required: Linear feet
Authorized State A nt Date
PWR Line
gallons
inches
So
to
31 t (� D
�%
1V
r
/arMt-K �z1Gre Cavo
PERMIT CONDITIONS
I. Performance:
11. 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 -Boz ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sew�$e disposal system on the above captioned property.
Type of system: El Conventional f�Z Other Z�/drliEU>r t+rrSeptic Tank- gallons Pump Tank
Subsurface No. of exact length width of depth of
Drainage field ditches .3 of each ditch /dD feet ditches 3 feet ditches 12'r
French Drain Required: Linear feet
Authorized State A nt Date
PWR Line
gallons
inches
16-5-38027 (1) 16-5-38027 (2) 16-5-38027 (3)
16-5-38027 (4)
16-5-38027 (6) 16-5-38027 (7) 16-5-38027 (8)
16-5-38027 (11) 16-5-38027 (12) 16-5-38027(13)
16-5-38027 (9)
16-5-38027 (5)
1
-?1 T
16-5-38027 (10)