OPHTE# S Harnett County Department of Public Health 24324
PERMIT # 2 0 / eration Permit
5 " New Installation Septic Tank De Nitrification Line ❑ Repair ❑ Expansior
/�
PROPERTY LOCATION: -J ` t .Q %T,�ce ifiJ
Name: (owner) Aa'iF
m� ex-- lii. SUBDIVISION � �,(�� LOT # 4
System Installer.y oNea Registration #
Basement with plumbing: ❑ Garage E l mber of Bedrooms —3
Type of Water Supply: ❑ Community Pablic ❑ Well Distance from well feet
System TYDe:ta Types V and YI Systems expire in S year.
(In accordance with Table V a) Owne wst coma Healt�eparty Department 6 months prior to expiration for permit renewal.
IAu system on been installed in compliance with applicable North Carolina General Stamus, Rules for Sewage Treatment and Disposal, and of conditions of the Improvement Permit and Cunauaion Authorization.
t �- th 2 S
1�
1
M
siv D �I
v
PERMIT CONDITIONS
1. Performance:
Il. 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 ❑ 112O1-ine
❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑
Conventional
Other 7'�1: An.�as� tic Tank: ! d 6 ea gallons Pump Tank gallons
Subsurface
No. of
S
exact length width of
depth of
Drainage Field
ditches
of each ditch 2oO feet ditches JL feet
ditchesinches
French Drain Required:
Linear feet
0 Authorized State Agiof /� (mss-�/ r � Date 12 —g - )
16-5-39013 (1) 16-5-39013 (2) 16-5-39013 (3) 16-5-39013 (4) 16-5-39013 (5)
i
M
Y
i . }
16-5-39013 (6) 16-5-39013 (7) 16-5-39013 (8) 16-5-39013 (9) 16-5-39013 (10)
r
16-5-39013 (11) 16-5.39013 (12) 16-5-39013 (13) 16-5-39013 (14) 16-5-39013 (15)
16-5-39013 (16)