OP RHTE# Ifs . 5�390�7 f- Harnett County Department of Public Health
24372
PERMIT # Zye96 0 eration Permit
—/
L�' New Installation EVfeptic Tank IR/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 52 14Z+ 6HpE61- 6rovr. ZJ
Name: (owner) SUBDIVISION LOT # 3
System Installer. To Co Registration #
Basement with plumbing: ❑ drage ❑ mber of Bedrooms
Type of Water Supply: ❑ Community Eir Public ❑ Well Distance from well feet
System Type: Z'M G 9 es V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact alth Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable Rout Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa$� disposal system on the above captioned property.
Type of system: ❑ Conventional G}x OtherziS�i�s �1U7_i1�J rkl% Septic Tank 1006 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _ of each ditch 90 feet ditches 3 feet ditches 2 Z inches
French Drain Required: Linear feet
Authorized State
r.
a784P3 Date / Z— 5_/(.
16-5-39077R (2) 16-5-39077R (3) 16-5-39077R (4) 16-5-39077R (5) 16-5-39077R (1)