OPHTE#y�lcvq- 3� �� Harnett County Department of Public Health 24471
PERMIT # !i <05 1,�,/ 0 eration Permit
L7 New Installation Septic Tank ErNitrification Line ❑ Repair ❑ Expansion
L "" PROPERTY LOCATIONts5U 9/0 S'C�Jrfr fi"!JS
Name: (owner)-Ua �(�111A� 4 iS�S SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supp1 : ❑ Community Public El Well Distance from well feet
System Type: 9s �p5es V and VI Systems expire in S years.
(In accordance with Table V a) J —� Owner must contaRHealth 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 Construction Authorization.
I. Performance:
II. Monitoring:
III. 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.
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewa a disposal sy t m on the above captioned property.
Type of system: ❑ Conventional Other 'j/l2e=cc Septic Tank: 460 ii gallons Pump Tank gallons
Subsurface No. of exact length width of depth of a
Drainage Field ditches 71 of each ditch 1-7-6 feet ditches 3 feet citchev?t-�'-4 inches
French Drain Required: Linear feet
Authorized State AgkL —L§ -z / VIA,,4 ,r.- ' Date
16-5-39494 (1)
16-5-39494 (2)
16-5-39494 (3)
16-5-39494 (4)
16-5-39494 (5)
16-5-39494 (6)
16-5-39494 (11)
16-5-39494 (7)
16-5-39494 (8)
16-5-39494 (12)
16-5-39494 (13)
16-5-39494 (9)
Y
16-5-39494 (14)
16-5-39494 (10)