OPHTE# I4-5-u�t3ti Harnett County Department of Public Health 24646
PERMIT # peration Permit
New Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: cot 1 (l7 I 52 /! t
Name: (owner) V3 0n n Lrot ; i —SUBDIVISION A„E; ecd LOT # Ir
System Installer: Registration #
Basement with plumbing ❑ Garageof Bedrooms
Type of Water Supply: ❑ Community ublic ❑ WeII Stance from well feet
System Type: 25% /L�., C>A S xf. . g Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system hu been installed in compliance with applicable North Carolina General Stamps. Rule, for Swaps Tmntmenr and mmmel -A A—dom...s d,. im.....m p.m.:. ,.d r ....... :.., a..a..:...:
PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 2'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for the sewa ,thiposal system on the above ca perry.
Type of system: ❑ Conventional 12r Other 64% /U -J Septic Tank: 17 6C.;, gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches T of each ditch feet ditches .3 feet ditches ZZ d- le inches
French Drain Required: Linear feet
Authorized State Agent / c�'4i 5 Date 0
I
Io'
N gfi yL.'9�RIo^�
s
o iJ n.eAln
r, C
r �
c -
s�o
P fl(.LL
PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 2'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for the sewa ,thiposal system on the above ca perry.
Type of system: ❑ Conventional 12r Other 64% /U -J Septic Tank: 17 6C.;, gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches T of each ditch feet ditches .3 feet ditches ZZ d- le inches
French Drain Required: Linear feet
Authorized State Agent / c�'4i 5 Date 0
r
.• rt a.7•s?16Y p4 j;riti,
IN
r,
_. ,;
2 L
14;y ir
.. r J
1
I�
I
r f
C