OPHTE# Lko� Harnett County Department of Public Health 24249
PERMIT # 2191" x Operation Pe It
Lv" New Installation Septic Tank Li' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:mt,Z& bUK4 /aA
Name: (owner) Ile—.c/ 444#70 /[GS /7rC SUBDIVISION LOT #
System Installer: 0 4DRegistration #
Basement with plumbing: ❑ Garage EY Number cl Be rooms 3
Type of Water Supply: ❑ublic i9 Well Distance from well 16d + feet
System Type: ZS Community ❑ P'T � Ri es V and VI Systems expire in S years.
(In accordance with Table V a) Owner must cortaccollealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with sociable North Carolina General Statutes. Rules for
12
PERMIT CONDITIONS:
I. Performance:
Il. Monitoring:
111. Maintenance:
IV. Operation:
wO..
and all conditions of the Improvement Permit and construction Authorization.
7b(L) y �
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.
,A,9A1 7,�/6,
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 1112O1-ine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional 70ther d'/• RacQ..e sa.r Septic Tank (moo gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 100 feet ditches S feet ditches ZD inches
French Drain Required: Linear feet
Authorized State ent �`� ' — ' Date
16-5-39065 (1)
16-5-39065(2)
16-5-39065 (3)
16-5-39065 (4)
16-5-39065 (5)
16-5-39065 (6)
16-5-39065 (7)
16-5-39065 (8)
16-5-39065 (9)
16-5-39065 (10)