OP RHTE#',53I�`y'TfoQ Harnett County Department of Public Health
24219
PERMIT # ;753b4 (P /0 eration Pe it
ri( New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOLATION-,X"& Oil.) 3,-4151' 2n
Name: (owner)S'%t�7t1C SUBDIVISION D0Aat/J /Jt�AS LOT # L_
System Installer: * Registration #
Basement with plumbing: ❑ Garage_/ umber of Bedrooms 3
Type of Watetto I�ply: El Community Lw7 Public ❑ Well Distance from well fee
System Type: 40 Z � — Ty es Syst ms expire in 5 years.
(In accordance with T le V a) Owner mus R ealth Department months prior to expiration for permit renewal.
This system has been installed is compliance with applicable North Caroli a wmaral Statutes, Rules for Sewage Treatment and Disposal, and d conditions of the Improvement Permit and construction
I. Performance:
It. Monitoring:
Ill. Maintenance:
IV. Operation:
V. Other.
i�
1
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 ❑ 1-12O1-ine
❑ PWR Line
Following are the
specifications for the sewage Aisposal system
Z�
on the above captioned property.
% %Y1G
0 0
1000
Type of system:
❑ Conventional 9' Other
�D �—
Septic Tank: 10 gallons
Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches 3
exact length
of each ditch 90 feet
width of
ditches -3 feet
depth of
ditches Zyf inches
French Drain Required: Linear feet
Authorized Stat6Q=��F049 Date
` 16-5-38446R (6) 16-5-38446R (7) 16-5-38446R (8) 16-5-38446R (9) 16-5-38446R (10)
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