OPHTE# 11.—s- 39z,u Harnett County Department of Public Health
24350
PERMIT # 2 6s- /0 eration Per it
EV New Installation EYI Septic Tank E? Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: X(/VA3 &p.:b
Name: (owner) Cvr-!w?g� =a c SUBDIVISION 7—*a o ...r2 LOT # �-
System Installer: `a -c -L G3 Registration #
Basement with plumbing: ❑ Garage De umber of Bedrooms 3
Type of Water Supply: ❑ Community L� Public ❑ Well Distance from well feet
System Type: & f�.>—I.�.�. �Tppes V and VI Systems expire in S years.
(In accordance with Table V a) Owner m c t tialth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with appliable North _CarolinaGe eml S�atmes, Rules far Sewage Treatment and DisposaI.Xd all condition of a Improvement Permit and Conummon Authorizadon
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
N� � r
ti
A
� ISD
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 se disposal system on the above captioned property.
Type of system: ❑
Conventional
Other VT viz o0ewOX rye z-- Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage field
ditches
Z of each ditch 17 a feet ditches 3
feet ditches Z (o — / inches
French Drain Required:
Linear feet
Authorized State ABEt---.A� L / ' ( Date 2
Y
16-5-39210 (1)
16-5-39210 (6)
16-5-39210 (2)
16-5-39210 (3)
16-5-39210 (4)
�.. ..-s,-�-_ •;.x ,.. aFP-.. .�. d,
16-5-39210 (7) 16-5-39210 (8)
16-5-39210 (11)
16-5-39210 (16)
16-5-39210 (12) 16-5-39210 (13)
16-5-39210 (9)
16-5-39210 (14)
16-5-39210 (5)
16-5-39210 (10)
16-5-39210 (15)