OPNTE# IG-°)- Harnett County Department of Public Health
PERMIT I Operation Permit 24436
Y4 New Installation 'N Septic Tank Nitrification Line ❑ Repair ❑ Expansior
Name:owner PROPERTY LOCATION:
S L o 1 i SUBDIVISION
System Installer. } v v �n e5 LOT #
Basement with plumbing ❑ Garage Number of Bedrooms Registration # `t'�'-t 3
SystemType:
Supply: ❑ community ❑ public X Well Distance from well I00
ys yp feet
(In accordance with Table V a) a Types V and VI Systems expire in S years.
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 sel''lle Treatment and Disposal, and all to i 11om of the Im rmemeat Permit and Construction Authoritarian,
G1 Au,E
ao
T-0 O
FL' A LOC)4, s
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I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑
Pump ❑
Alarm ❑
Following are the specifications for the sewage disposal system on the abov
H2OLine ❑ PWR Line
Type of system: ❑
conventional
captioned property.
i
Other ChAM C°J11' )
Subsurface
No, of
exact length
Septic Tank: 100 G
gallons Pump Tank:
Drainage Field
French Drain Requir
dict \
es
of each ditch � feet
width of
ditches 3
gallons
depth of
feet ditches �
at (aK)C)6
inches
Authorized State
Date
i � 5-3':�� g3"b3