OPHTE# Z s- y/ 5 G Harnett County Department of Public Health 24771
PERMIT #�� j 0 eration Pe it
2( New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:
Name: (owner) l✓e-&V-T ZLIf SUBDIVISION LOT # 6
System Installer. Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms 3
Type of Wate Supply: ❑ Community IJ Public ❑ Well Distance from well feet
System Type: AT Li T es S stems expire in S years.
(In accordance with Table V a) —' —`04ner must contact Health Department 4 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina Gleaned Statutes, Rules for TIAtment and Disposal, and 41 conditions of the Improvement Permit and (instruction Authorization
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
If. 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 -Boz ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sa dispos I system on the above captioned property.
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Type of system: ❑ Conventional Other -�-s/Z 16141 Septic Tank: 066 gallons Pump Tank Oy gallons
Subsurface No. of exact, width of depth of
Drainage Field ditches 3 of each ditch 2"6 feet ditches 3 feet ditches inches
French Drain Required: linear feet
Authorized State Agentil- ,- o—� �fAnlh �fA ` � Date
FROM 12;0?
114
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17-5-41456 (1) 17-5-41456 (2) 17-5-41456 (3) 17-541456 (4) 17-5-41456 (5)
17-5-41456 (6) 17-5-41456 (7) 17-5-41456 (8) 17-5-41456 (9) 17-5-41456 (10)
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17-5-41456 (11) 17-5-41456 (12) 17-541456 (13) 17-5-41456 (14) 17-541456 (15)
17-541456 (16) 17-5-41456 (17) 17-541456 (18) 17-5-41456 (19) 17-5-41456 (20)