OP RHTE# 1L-r-39ytegP Harnett County Department of Public Health 24325
PERMIT # Z`3d-7s/ 0 eraf P It /
d New Installation Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION;rV I SSy IQCC-)J
Name: (owner) _��% rA2 Znk_ SUBDIVISION LOT #
System Installer: /lel: ) Ko Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedr oms 3
Type of Water Suppl : ❑ Community ❑ Public Eir Well Distance from well /Oe w + feet
System Type: ,R�a�,� Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewaeedtreatment and Disposal, and all conditions of
PERMIT CONDITIONS
I. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
M
I �L
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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 30D feet
Alarm ❑
H2OLine ❑
and Construction Authorization.
Septic Tank: 10 0 O gallons Pump Tank:
width of depth of
ditches 3 feet ditches ZO->18
French Drain Required: Linear feet
/ �f•F' S
Authorized State A cat 4 /ti +�f��f72 Date 17,
v e
PWR Line
gallons
inches
16-5-39464R (1)
16-5-39464R (6)
16-5-39464R (2)
16-5-39464R (7)
16-5-39464R (3)
16-5-39464R (4)
16-5-39464R (5)
16-5-39464R (8)
16-5-39464R (9)
16-5-39464R (11)
16-5-39464R (16)
16-5-39464R (12)
16-5-39464R (13)
16-5-39464R (14)
16-5-39464R (10)
16-5-39464R (15)