OPHTE# Ido -� 39s L Harnett County Department of Public Health 24323
PERMIT # 2"/x.3/ 0 eration Pe It /Nitrification
l� New Installation Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOfAT10 72-0 Ra�Af 20
Name: (owner) �rt.P¢cQdv ��a� s�sz SUBDIVISION LOT# fy
System Installer: Registration #
Basement with plumbing: ❑ Garage ��umber of Bedrooms 3
Type of Water Supp . ❑ Communi LPublic El Well Distance from well feet
System Type: 2 FlFt5o Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must cofffacttyalth Department 6 months prior to expiration for permit renewal.
Ibis system has been installed in compliance with applimble North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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PERMIT CONDITIONS:
I. Performance:
IL Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew gle disposal system on the�bove captioned topyry
Type of system: ❑ Conventional Other 9 °%b ICad/t�sf% .;—N St✓�>~ Septic Tank: Q/ b d gallons Pump Tank: gallons
Subsurface No. of exact length T width of depth of �r
Drainage Field ditches of each ditch 100 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized Stat ent %dN Date /Z' S
0
16-5-39586 (1)
16-5-39586 (2)
16-5-39586 (3)
16-5-39586 (4)
16-5-39586 (5)
16-5-39586 (6)
16-5-39586 (7)
16-5-39586 (8)
16-5-39586 (9)