OPHTE# Ili - s -3y Harnett County Department of Public Health 24203
PERMIT # d 0 eration -Permit /
New Installation Septic Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION;6r173-I-AAVf'ocl d2Lrt e-�
Name: (owner) s ad vn SUBDIVISION LOT # S
System Installer. , 5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community N Public ❑ Well Distance from well feet
System Type: 5% -Du 5 T u <- --z- t4 -- 11pes V and VI Systems expire in S years.
(In accordance with Table V a) Owner must cant- c ealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Stances, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and tonstmaion Aumorizanon.
T>Az5='
I % o
IS
PERMIT CONDITIONS
1. Performance:
11. Monitoring:
111. 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 Cl Alarm ❑ M201-ine ❑ PAIR Line
Following are the specifications for the sewa$k disposal system on the above captioned property.
Type of system: 11COther ?$ 12-'*11� U-241 Ld Septic Tank: 1 gallons Pump Tank gallons
Subsurface No. of exact length O width of depth of o
Drainage Field ditches N of each ditch 00 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized Stag ��-'-�- ` � ��`y�� - Date
16.5-38364 (1)
16-5-38364 (2)
16-5-38364 (3)
16-5.38364 (4)
16-5-38364 (5)
16-5.38364 (6)
16.5-38364 (11)
16-5.38364 (7)
L
16.5.38364 (12)
16-5-38364 (8)
16-5-38364 (9)
16-5-38364 (10)