OPHTE# 1-7-S-'(lOr 59 Harnett County Department of Public Health 24489
PERMIT # ZS3Z'). / Operation P mit
New Installation Septic Tank 2� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO .
Name: (owner) jrPe SUBDIVISION /�rio-m/z LOT # <�
System Installer: T Registration #
Basement with plumbing: ❑ Garage �/ umber of Bedrooms 3
Type of Water Sup I : ❑ Community Lv1 Public ❑ Well Distance from well feet
System Type: / U a `/ y V and VI Systems expire in 5 years.
(In accordance with Table V a) 7 1 to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina Generd tztutes Rules for Sewage Treatments and DispowL and all conditions{A//f the Improvement Permit and Construction Authorization.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
Other.
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Cvr�SS i�� �
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 sewage A sposal system onn the ove capt oned property.
Type of system: ❑ Conventional E Other-�%/lad/i, r Septic Tank: 100 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of a
Drainage Field ditches of each ditch Z S feet ditches 3 feet ditches i� � inches
French Drain Required: Linear feet
Authorized State Ateut� l wIA-(AIO_� 16:S711,7_1 Date
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17-5-40659 (1) 17-5-40659 (2) 17-5-40659 (3) 17-5-40659 (4) 17-5.40659 (5)
17-540659 (6) 17-5-40659 (7) 17-5-40659 (8) 17-5-40659 (9) 17-5-40659 (10)
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17-5-40659 (11) 17-5-40659 (12) 17-5-40659 (13) 17-5-40659 (14) 17-5-40659 (15) VE—ii
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17-5-40659(16) 17-5-40659(17) 17-5-40659(18) 17.5-40659(19) 17-5-40659(20)
177
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