OPHTE# IL—'S---3 Harnett County Department of Public Health
24364
PERMIT # ZMA 0 eration Permit
New Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIOILSit
Name: (owner) 5 SUBDIVISION / LOT # 6—
System Installer. �7-A Registration #
Basement with plumbing: ❑ Garage umber of rooms q
Type of Water Supply: ❑ Community C3 Public Well Distance from well feet
System Type: ��o R sfg� � 6 &Z ypes V and A Systems expire in S years.
(In accordance with Table V a) er t Contac Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with appliable North Carolina General Statutes, Rules fo a re ent and Disposal, and all conditions of the Improvement Permit and construction Authorization.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
F
4 BGs^—
Y7
3l0 cw
—v'1
I
Lr
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 ❑ 11201-ine ❑ PWR Line
Following are the
specifications for
the sewage disposalstem on the above captioned property.
Type of system:
El Conventional
f3 Other lS n % C eZtl1�
Septic Tank:Zoy gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditchesAJ
of each ditch 10 O feet
p„
ditches 3 feet ditches Z7 inches
French Drain Required: Linear feet
�'I
Authorized State Agent Date _ N — JO — 11
16-5-38635 (1)
16-5.38635 (2)
16-5-38635 (3)
16-5-38635 (4)
16-5-38635 (5)
16-5-38635 (6)
16-5-38635 (7)
16-5-38635 (8)
16-5-38635 (9)
16-5-38635 (10)
16-5-38635 (11)
16-5-38635 (12)
16-5-38635 (13)
16-5-38635 (14)
16-5-38635(15)