OPHTE# /G"s ,M71 Harnett County Department of Public Health 24224
PERMIT # Z $$C1 / Operation Per It
New Installation Y Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /Z/J
Name: (owner) SUBDIVISION LOT # 3
System Installer. Registration #
Basement with plumbing: ❑ Garage mber of Be ms
Type of Water Isply: ❑ Community Public ❑ Well Distance from well feet
System Type: T—» 14&0Lei /» ��%/( ,�.6 e�;-40 iyaes V and VI Systems expire in S years.
(In accordance with fable V a) Owner must contacQlealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (onstmztion Authorization.
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PERMIT CONDITIONS
I. renormance: system snan penorm In accordance wan Nule .lrol.
11. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sew disposal syste on t above captioned proper
Type of system: ❑ Conventional Other N � r; Sept ank: /7 J gallons Pump Tank' ��y gallons
Subsurface No. of exact lengt /-F width of q depth of
Drainage Field ditches of each ditch r feet ditches J feet ditches inches
French Drain Required: Linear feet
Authorized State Aged ),!!� L /I/ Date
Y
16-5-38971 (1) 16-5-38971 (2) 16-5-38971 (3) 16-5-38971 (4) 16-5-38971 (5)
I W
16-5-38971 (6) 16-5-38971 (7) 16-5-38971(8) 16-5-38971 (9) 16-5-38971(10)
r
16-5-38971 (11) 16-5-38971 (12) 16-5-38971 (13) 16-5-38971 (14) 16-5-38971 (15)
Wl
`*'•
16-5-38971 (16) 16-5-38971 (17) 16-5-38971 (18) 16-5-38971 (19) 16-5-38971(20)
4W
16-5-38971 (21)