OPHTE# ra 5-4°Su Harnett County Department of Public Health 24656
PERMIT # 29304 eration Permi
New Installation Septic Tank„ 0 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ %o eI,,jg �f�L=ten d (d�fSf
Name: (owner) )p6hs,�. C3lc.cl�.e�n SUBDIVISION__ 2e
mr J- 5
System Installer: Cvey ; /�� LOT #
Registration #
Basement with plumbing: ❑ Garage ( mbstr of Bedrooms
Type of Water Supply: ❑ Community 2-lublic ❑ Well Distance from well feet
System Type: 25%0 rZtJc.'li '-. n_�—� Types V and VI Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
has been installed in
General Statutes, Roles for Sewage Treatment and Disposal and all Conditions of the
f 11)�
^ ID
I • f'y.E
Imo,
Sys
2b,
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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.
and construction Authorization.
� I tanks 5,.5 FE vG�
5,=tom
,T' -f' {�- 6a tLar
Qj; 54i -
❑
D -Box
❑ Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
Type
s�
332 .g Gs,
C
cher F4 r% . ,x, / L
Septic Tank:
/(Xjrj gallons Pump Tank: t��-+Ci gallons
tl!
ditches
v
width of
3 depth of
French Drain Required:
Dy �z
2b,
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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.
and construction Authorization.
� I tanks 5,.5 FE vG�
5,=tom
,T' -f' {�- 6a tLar
Qj; 54i -
❑
D -Box
❑ Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
Type
the sewage disposal system on the above wptione�erry.
of system: ❑
Subsurface
Conventional
No. of
cher F4 r% . ,x, / L
Septic Tank:
/(Xjrj gallons Pump Tank: t��-+Ci gallons
Drainage Field
ditches
exact length
3 /G�>
of
of each ditch feet
width of
3 depth of
French Drain Required:
feet
ditches
feet ditches Z -inches
Authorized State Agent_aE Date S T ) 2_C>l
f.
;tg
gy�
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i
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