OPHTE# ffo—S - `100&,8 Harnett County Department of Public Health 24328
PERMIT # z fS 3/ 0 eraf Pe It
d New Installation Septic Tank [it/ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION:6c-/5W sa, -, v,
Name: (owner) -< jy�:„ SUBDIVISION LOT #
System Installer: (LA i7 x -S Registration #
Basement with plumbing: ❑ Garage ❑ Number of Be Looms .3
Type of Water Supply: ❑ Community d Public Cir Well Distance from well /06 ` feet
System Type: Z6 A ---1i-- 3r . t ,_ z: .,yr r r E—, rr_� 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.
miss stem on Ween instilled in Compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conswaion Authorhation.
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
111. 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 -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal syy?�tem on the above captioned property.
Type of system: El Conventional Other 7 Septic Tank: 1 J v o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches I of each ditch -3 fix' feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agen - ? - . Date I
16-540068 (1)
16-5-40068 (6)
16-540068 (11)
16-5-40068 (2)
16-5-40068(7)
16-540068 (12)
16-5-40068 (3)
(
16.5.40068 (8)
16-5-40068 (4)
i
16-5-40068 (9)
16.540068 (13)
16-5.40068 (14)
16-5-40068 (5)
ow
R` 16-5-40068 (10)