OPHTE# elf' 5 _-593 0 Harnett County Department of Public Health 24330
PERMIT # Z8969 �erati�n Permit
❑' New
Installation Septic Tank Z Nitrification Line ❑ Repair F-1 Expansion
PROPERTY LOCATION: 3C 1006 Di/.> ss G -�— le--)
Name: (owner) G SUBDIVISION 094W) eJa»,0 s LOT # L
System Installer: Registration #
Basement with plumbing: ❑ Garage �umber of edrooms 3
Type of Water Supp l : EJ Community L'J Public ❑ Well Distance from well f et
System Type: 5 91i ITa.P— i%i /� Cis*— Types V and VI Sstems expire in S years.
(In accordance with Table V a)I Owner InDtt SHealth Department 6 months prior to expiration for permit renewal
This system has been installed in
Treatment and Disposal, and all conditions of the Improvement Pennit and Construction Authorization.
13
wzans j?
11)05 6.c14p,
I. Performance:
System shall perform in accordance with Rule .1961.
ll. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and
reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑ H2OLine
Cl PWR Line
Following are the specifications for the sewak disposal system on the above captioned property.
Type of system: ❑
Conventional E2r Other ZS ?s IV
Septic Tank: 10 gallons
Pump Tank: r "y 0 gallons
Subsurface
Drainage Field
No. of exact length
ditches of each ditch 0r) feet
width of
ditches feet
depth of
ditches 7rZ inches
French Drain Required: Linear feet
Authorized State Agetst Date
1.!M� #.
16-5-39320 (1) 16-5-39320 (2) 16-5-39320 (3) 16-5-39320 (4) 16-5-39320 (5)
------------------------
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1 1 1 1 1 1
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16-5-39320 (11) 16-5-39320 (12) 16-5-39320 (13) 16-5-39320 (14) 16-5-39320 (15)