OPHTE# 14 -6--4cjez Harnett County Department of Public Health 24623
PERMIT # Z43o6eratI Perf
New Installation Septic Tank Fr' Nitrification Line ❑ Repair ❑ Expansion
,-For% paSL3 C{,Sf;as PROPERTY LOCATION: lBS (?L rho , rza, d rsn 144(0
Name: (owner) --rGrrn+w lmw% r, -5 SUBDIVISION LOT #
System Installer: QlZ C1 n x S &A4k' Registration #
Basement with plumbing: ❑ Garage E hpleer of Bedrooms _
Type of Water Supply: ❑ Community 12 Public ❑ Well Distance from well feet
System Type: 'Z-5% (L --A nr L "c n 5 �I 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.
MS System has been installed In Compliance with applKable north Carolina General Statutes, Rules for Sewage Treatmem and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 LTJ ¢)aoll,-i oT Pump 16 8E�,7 o\ Alarm ❑ H2OLme ❑ PWR Line
Fallowing are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional l�r 457- Septic Tank: /CCYj gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch CSO feet ditches 3 feet ditches inches
French Drain Required: inear feet
Authorized State Agent Date glsokl
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 LTJ ¢)aoll,-i oT Pump 16 8E�,7 o\ Alarm ❑ H2OLme ❑ PWR Line
Fallowing are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional l�r 457- Septic Tank: /CCYj gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch CSO feet ditches 3 feet ditches inches
French Drain Required: inear feet
Authorized State Agent Date glsokl
N"',
to