OPHTE# Ib S�39247 Harnett County Department of Public Health 24196
PERMIT # %.4iCi6 c7 Operation Pe colt
d Neww installation EVSeptic Tank Nitrification Line Repair El Expansion
/+ PROPERTY LOCATION: lf�ce2�,S:
Name: (owner) Pg/td,' C,UAw,y?J SUBDIVISION LOT #
System Installer. F-��. Registration #
Basemen[ with plumbing: ❑ Garage ❑ lumber of Be ooms
Type of Water Supply: El Community Public Well Distance from well /&d r feet
System Type: /wnJ µ[ �'(� Types Y and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constructions Authoruation.
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
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
❑ H2O1-ine
❑ PWR Line
Following are the
specifications for the se Re disposal
ssss em on the above
captioned 4roperty.
y
Type of system:
❑ Conventional 1�" Other I
1 G/L= (kA
a 2 �c _/ —
Septic Tank: 2�s5 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches 2
of each ditch
I 0 0feet
ditches feet
ditches r t',_ inches
hrench Drain Required: Linear Leet
Authorized State Agent t- , 2 Date