OPHTE# 14-s- -:Mz Harnett County Department of Public Health 24174
PERMIT # 2904 -1_ /Operation Pe It /Nitrification
New Installation Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOCATION0t/Y'K9/fr/ZdS.4
Name: (owner) ra� / �� SUBDIVISION 44k,t=i'>,S Jill- WU LOT # 9
System Installer: �% u.z Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _5
Type of Water Supply: ❑ Community fids Public ❑ Well Distance from well feet
System Type: T V and VI Systems expire in 5 years.
(In accordance with table V a) Owner must contact alth 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 tonstruamn mumomanon
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 sewage disposal
system on the above captioned property.
Type of system:
❑ Conventional ❑ Other 1205"4
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Septic Tank: / OlIP49 gallons
Pump Tank gallons
Subsurface
No. of
3
exact length
width of
3
depth of
12
Drainage Field
ditches
of each ditch 00 feet
ditches feet
ditches inches
French Drain Required: Linear feet
Authorized State Ag e yifnl Date 7-2rl
Q—&
16-5-38165 (1)
16-5-38165(6)
16-5-38165 (2)
16-5-38165 (7)
16-5-38165 (3)
16-5-38165 (8)
16-5-38165 (4)
16-5-38165 (5)
y4 V-
16-5-38165 (9)
16-5-38165 (10)
16-5-38165 (11)
16-5-38165 (12)
16-5-38165 (13)
16-5-38165 (16) 16-5-38165 (17) 16-5-38165 (18)
16-5-38165 (14)
16-5-38165 (15)