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OPHTE# ' I f-s = d-7, 1-W Harnett County Department of Public Health PERMIT # d kl;7 s'k Operation Prerrit 2 2 0 4 6 ® New Installation L~J Septic Tank ~ Nitrification Line ❑ Repair ❑ Ex ansion P PROPERTY LOCATION: PA:-- LQ4 R~ Name: (owner) . i. k-ir-,ti S-3 e,r SUBDIVISION "d LOT System Installer: ' !ty ✓~a Registration # Basement with plumbing: ❑ Garage E❑ umber of Bedrooms 3 Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet System Type: G-- Types V and VI Systems expire in 5 years. (In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal. 11115 oyxe111 nas ueen Insianea in with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the a s y a r eS \C 3 a /v S _ f ~ I C s L/ X PL PERMIT ("UnITIM- Permit and Construction Authorization. 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: ❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line following are the specifications for the seww disposal system on he above captioned property. Type of system: ❑ Conventional 1 Other C Z +F~o~ Septic Tank: 2000 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch 6 © feet ditches 3 feet ditches ~Y-.. u inches French Drain Required: Linear feet Authorized State Agen~/,J,-,~ ~rl~ Date II_s=CA-1 J tip`, ..r z p gel 410 ~¢s ~P k