OPHTE# - A57:-- z Harnett County Department of Public Health 24265
PERMIT # 290 KO �A eration Perpt
New Installation EYSeptic Tank Nitrdfcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 119 4rAb:, c cJ
Name: (owner) AV6i' S9RDIVISION LOT #
System Installer: el�114�4%8 Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bedrooms
Type of Water Su ly: ❑ Communryi � f� Public ❑ Well Distance from well feet
System Type: -,..Dote Types V and VI Systems expire in S years.
(In accordance with table Y a) Own r fytccg3ct Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General smother, Rules for
PERMIT CONDITIONS:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
and Dispel, and all conditions of the
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.
Permit and Construction Authorization.
❑ D -Bax ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal s stem�on th�jabove captioned property.
Type of system: ❑ Conventional ❑ Othermu= Septic Tank: 600 gallons Pump Tank: gallons
Subsurface No. of ' exact length width of 3 depth of QF
Drainage Field ditches of each ditch Z d feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Ag t Date
16-5-39672 (1)
16-5-39672 (2)
16-5-39672 (3)
16-5-39672 (4)
16-5-39672 (5)
16-5-39672 (6)
16-5-39672 (7)
16-5-39672 (8)
16-5-39672 (11)
F.
16-5-39672 (16)
16-5-39672 (12)
16-5-39672 (13)
16-5-39672 (9)
16-5-39672 (14)
16-5-39672 (10)
16-5-39672 (15)