OPHTE# 1 I -S- QXL.4 Harnett County Department of Public Health 24640
PERMIT # i.%1¢jtii,0 eration Per
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: ?V%nti C i 5r. I4o3)
Name: (owner) SLe-bl, ak k 3 S v SUBDIVISION LOT # are
System Installer: ti Registration #
Basement with plumbing ❑ Garage� /u tuber of Bedrooms_
Type of Water Supply: El Community LK" Public ❑ Well Distance from well feet
System Type: 2� % O,�y "orl 5 s - c Types V and VI Systems expire in S years.
(In accordance with Table V a) Ownermust contact Health Department 6 months prior to expiration for permit renewal.
Ibis system has been installed in compliance with appritable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improeemem Permit and Consm enon Authoritarian.
1
vl
\
Vv
L 2,
i5`o UP.
L
M1?.PArrl Art S4
� %gip"21s I
�—
� 3152 51=� a�
z
c
1
\
1 <
Kt PL1 2h LSrt. ILd (tea
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sewag�e ssposal system on the above captioned property.
Type of system: E3 Conventional Q' Other Cy rt,,,, Septic Tank: tpL-,6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch LZ6 feet ditches 3 feet ditches LZ —)IA inches
French Drain Required: Linear feet /
Authorized State Agent 1��� % Date 04j 11 126i-q-
N
�9
R�
rj
1