OPHTE# I &1 5 AJ 41 Harnett County Department of Public Health 24625
PERMIT # Z yza 1- 0 eration Permi
New Installation eptic Tank ler_ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: e 6g2t 1-4C6 LA- WI 52 /v�
Name: (owner) Q4An C�xnS(/ix�; ink . SUBDIVISION LOT # 16
System Installer. ; Registration # A
Basement with plumbing: ❑ Garage ,.., tmber of Bed ms q
Type of Water Supply: El Community 9— ruiDllc ❑ Well Of use from well feet
System Type: 25 io 1adQol.on 5„5. 111 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 applicable North Carolina General Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
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 sewage sal system on the above wptian_ed
Type of system: ❑ Conventional Other e�7 Septic Tank: 12 Sd gallons Pump Tank gallons
Subsurface No. of exact length width of depth of e�
Drainage Field ditches 5 of each ditch 0' D feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent f Date dV �d
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