OP RHTE# 1lo—S-3o q Harnett County Department of Public Health 24193
PERMIT # ZSSWj /Operation Per 't /
New Installation Septic Tank E9wltrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: zit J9 <3
Name: (owner) C&*s6And;R4n SUBDIVISION LOT #
System Installer. o Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community F9/Public ❑ Well Distance from well feet
System Type: 2�lo S r Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must coT6ct Health Department 6 months prior to expiration for permit renewal.
This system has been installed in ampliana with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constmttion Authorization
I� Z✓yo
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PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961. Z/24 9153
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa$disposal system on the above captioned property.
Type of system: ❑ Conventional 13� Other .?:g& f ;3o u'Zv' Septic Tank gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches LO inches
French Drain Required: Linear feet
Authorized State nt Date —Z'21 —
16-5-38404 (1)
16-5-38404 (2)
16-5-38404 (3)
16-5-38404 (4)
16-5-38404 (5)
16-5-38404 (6)
16-5-38404 (7)
16-5-38404 (11) 16-5-38404 (12)
16-5-38404 (8)
16-5-38404 (9)
16-5-38404 (10)