OPNTE#�CJ `..5yy �OYS� Harnett County Department of Public Health
24519
PERMIT # 49(VI i0 eration Per It
New Installation Y Septic Tank ERI Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: WA
Name: (ovvner)—J - z—g 3 SUBDIVISION ! �Js�l2fs Q )�— LOT #
System Installer:5V`7-4g—� 9 /42 �— Registration #
Basement with plumbing: ❑ Garage ETumber of Bedrooms .3
Type of Water Supply: El Community LiJ Public ❑ Well Distance from well feet
System Type: Z`2-/, ib—mss P?TypesV and VI Systems expire in S years.
(In accordance with Table V a) ' Owner must cothafridth Department 6 months prior to expiration for permit renewal.
Ibis system has been installed in compliance with applicable Nonh 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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwage"disposal system on the above captioned roperty.
Type of system: ❑ Conventional tr7 Other s ac ci Septic Tank d gallons Pump Tank: gallons
Subsurface No. of exact length / width of depth of r v
Drainage Field ditches_ of each ditch Un feet ditches -3 feet ditches_ inches
French Drain Required: Linear feet
Authorized State, Agent l IV4' "Date 10-13.—
16-5-40455 (1)
16-540455 (2)
16-5-40455 (3)
16-5-40455 (4)
16-5-40455 (6)
16-540455 (7)
16-5-40455 (11) 16-5-40455 (12)
16-5-40455 (8)
16-5-40455 (13)
16-5-40455 (9)
16-540455 (5)
Ed
16-5-40455 (10)
16-5-40455 (2)
16-5-40455 (3)
16-5-40455 (4)
16-5-40455 (5)
16-5-40455 (6)
16-5-40455 (7)
16-5-40455 (8)
16-5-40455 (9)
16-540455 (12) 16-540455 (13) 16-5-40455
16-5-40455 (11)