OP RHTE# AQ-52SAC Harnett County Department of Public Health 24221
PERMIT # ?1000 /0 eration Per It /
Lie' New Installation Septic Tank cr Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:SI_ -1:5l�ftS a N
Name: (owner) iL- 6-X: SUBDIVISION LOT #
System Installer: aA !ate Registration #
Basement with plumbing: ❑ Garage mber of Bedrooms
Type of Water Suppl : CommunitynPublic ❑ Well Distance from well feet
System Type: /('0-4— c.. ��6IQ2 f Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner l ust contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable North Carolina General Starnes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in acco
Il. Monitoring: As required by Rule .1961. -26L— f
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal sys�temt on the /a/bove ca -tioned pro erty.
Type of system: ❑ Conventional 70ther 7's!l't�tY l� 6 Zf' / Septic Tank 100 -0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch _:7±5— feet ditches 3 feet ditches 2 inches
French Drain Required: Linear feet
r a L49ft—�" ��L�1217"Mod� I.
16-5-39025R (1)
16-5-39025R (2)
16-5-39025R (3)
16-5-39025R (4)
16-5-39025R (6)
16-5-39025R (7)
16-5-39025R (8)
16-5-39025R (9)