OPNTE# Ak-,� Harnett County Department of Public Health 24229
PERMIT # ZWf A eration Pertii/it
11 New Installation Y Septic TankNitrification Line ❑ Repair ❑ Expansion
�y n _ PROPERTY LOCATIX,:T /V37FJoPQ�a(J�/
Name: (owner) aAlyee / �' (CG SUBDIVISION Ae�(,x os LOT # 17,2
System Installer. Tb/ i Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms j
Type of Water Suppl : -:2Community IVublic ❑ Well Distance from well feet
System Type: %
(In accordance with Table V a)
This system has been installed in
V and VI Systems expire in S years.
,Department 6 months prior to expiration for permit renewal.
with applicable North Carolina General Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I. Performance:
System shall perform in accordance with Rule .1961.
'
II. Monitoring:
As required by Rule .1961.
III. 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 ❑ PAR Line
Following are the specifications for the sew a disposal system on the above captioned properly.
Type of system: El
Conventional Other W-119L£AJG7 �_ V�
Septic Tank l40c
gallons Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage field
ditches f of each ditch 3Dd feet
ditches 3
feet ditches inches
French Drain Required:
Linear feet
Authorized State A
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,enc Z O" I
Date
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16-5-38101 (1) 16-5-38101(2) 16-5-38101(3) 16-5-38101 (4) 16-5-38101 (5)
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16-5-38101(6) 16-5-38101 (7) 16-5-38101 (8) 16-5-38101 (9) 16-5-38101 (10)
SKI law,
16-5-38101(11) 16-5-38101 (12) 16-5-38101(13) 16-5-38101 (14) 16-5-38101 (15)
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16-5-38101(16) 16-5-38101 (17) 16-5-38101 (18) 16-5-38101 (19) 16-5-38101 (20)
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16-5-38101 (21) 16-5-38101 (22) 16-5-38101 (23) 16-5-38101 (24) 16-5-38101 (25)
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16-5-38101 (26) 16-5-36101 (27) 16-5-38101(28) 16-5-38101 (29) 16.5-38101 (30)