OPHTE#S-391 (o Harnett County Department of Public Health
�$� 24380
PERMIT # 0 erati9" Per it
L� New Installation Septic Tank 9--Nitrification Line ❑ Repair ❑Expansion
PROPERTY LOCATION: 4V i i%< 2 a
Name: (owner) (Lc� N\ ab Ql SUBDIVISION A�rk;ns V: it 4,p LOT #
System Installer: jj�nI-Akin Registration #
Basement with plumbing: ❑ Garage Y)Iumber of Bedrooms
Type of Water Supply: ElD Community Public ❑ Well Distance from well feet
System Type: ✓ C, 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.
This system has been installed in compliance with applkable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authonzation.
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PERMIT CONDITIONS -
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No [BF'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the se�wagedi3P°w system on the above to boned pr erty.
Type of system: El Conventional Of ,��63%i Septic Tank: /4� gallons Pump Tank: gallons
Subsurface No. of / exact length width of depth of
Drainage Field _, s 7 of each ditch feet ditches .5 feet ditches X,42/ inches
French Drain Require -.Linear feet
Authorized State
Date
K - 5-3% A (z,