OPNTE# I L -5 -Jqg z 5 Harnett County Department of Public Health 24630
PERMIT # Z4651 ORration Permi /
New Installation �
Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: It"' lrvslC Dr (Tt ..6 Abiis4J Mia/ "\
Name: (owner) L; dlty Cnce�) r�L SUBDIVISION 4FI,a e_G
9. Gn-e�LOT #
System Installer: les CL. Il r Registration # 379
Basement with plumbing. ❑ Garagey1 mher of Bedrooms 44
Type of Water Supply: EJ Community CYPublic ❑ Well Distance from well feet
System Type: Z I a n s .Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner m contact Health Department 6 months prior to expiration for permit renewal.
oris 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.
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PERMIT CONDITIONS
I. Performance:
11. 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 C9'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑
❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional T her g (--e ora =_11" Septic Tank: ) Z 5 6 gallons Pump Tank:
Subsurface No. of exact length 1-1 width of depth of
Drainage Field ditches 3 of each ditch /00 feet ditches 3 feet ditches —i /cg
trench Drain Required: Linear feet
Authorized State Agent 4 Date051ZoE--4—
PWR Line
gallons
inches
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