OPHTE# )(,-s- Li 0300 Harnett County Department of Public Health
24346
PERMIT # ;"5 Operation Permit
New Installation Septic Tank E? itrification Line ❑ Repair ❑ Expansion
1
PROPERTY LOCATION:a,.5W_ mo� '?
o'- Zf
Name: (owner) F44-xr eil SUBDIVISION -:7-5 0 LOT # L�
System Installer: z�.3 Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 3
Type of Water Supply: ❑ Community 0 Public ❑ Well Distance from well feet
System Type: tin LQ � fu T Li+xi 6 -Eza-n� Types V and VI Systems expire in S years.
(In accordance with Table V a) 1 Owner must contfacctt 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 Sewage Treatment and Disposal. and all conditions of the Improvement Permit and Conumction Authorisation
rcnnss c.unuutuns:
I. Performance:
II. 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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa a disposal system on the above captioned proRerty.
Type of system: ❑ Conventional 70ther 25°�s 17%�p L- U -s _ SSsiZ— Septic Tank: 100 o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch 12 0 feet ditches feet ditches Zi t inches
french Drain Required: Linear feet
Authorized State Agent_ Date
16-5-40300 (1)
16-5-40300(2)
16-5-40300 (3)
16-5-40300 (4)
16-5-40300 (6)
16-540300 (7)
16-5-40300 (8)
16-5-40300 (5)
I' 9
.M
16-5-40300 (10)
16-540300 (11)
16-5-40300 (13)
16-5-40300 (14)
16-5-40300 (15)