OPNTE# 1'1—S-1 — Lf 3 Harnett County Department of Public Health 24773
PERMIT#_Z93r1 eration Permit /
Ed New Installatio�c Tank C�' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION_PyU:/9,Vr-74r-4,s
Name: (owner) c57 f /31SUBDIVISION Avrg v— U .�¢ LOT # 2�V_
System Installer: �N� /�k�90_ _ Registration #
Basement with plumbing: ❑ Garage 19 Number of Bedrooms _ 4L
Type of Water Supply: ❑ Community I ' Public ❑ Well Distance from well feet
System Type: `4 i pes V and V1 Systems expire in S years.
(In accordance with Table V a) Owner must con t Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Sawn Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (onmucdon Authoritarian
PERMIT CONDITIONS
I. Performance:
H. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
4 --b-
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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 sewage disposal system on the a ave captioned property.
Type of system: El Conventional Other 75% Septic Tank: 17& o gallons Pump Tank: gallons
Subsurface No. of exact length q width of depth of
Drainage Field ditches �l of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State AAeg___ P.r—. -� >. fi Date ll—z—
17-5-40973 (1) 17-5-40973 (2) 17-5-40973 (3) 17-540973 (4) 17-5-40973 (5)
sr1 1\ I �.
f
17-5-40973 (6) 17-540973(7) 17-5-40973 (8) 17-5-40973(9) 17-5-40973(10)
17-5-40973(11) 17-5-40973(12) 17-5-40973(13) 17-5-40973(14) 17-540973(15)
17-5-40973(16) 17-540973 (17) 17-540973 (18) 17-5-40973(19) 17-540973 (20)
Y
i
17-5-40973(21) 17-5-40973 (22) 17-5-40973(23) 17-540973 (24) 175-40973 (25)