OPHTE# lL s -Zwr Harnett County Department of Public Health
PERMIT #ry'3~ Operation Per it /Witrification 2 2 2 81
Ei New Installation Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ry&o63 / .ti--v7- a 46
Name: (owner) /f~ tea, !>4 SUBDIVISION t yrt~! i~,i 8Z LOT # l i
System Installer: Registration # 11-1
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: 011, blvbucf,4)> 754 60_ e_ ' Z t 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
1. Performance:
If. 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
❑ H20Line ❑ PWR Line
Following are the specifications for
the sewa a disposal system on the above captioned property.
Type of system:
❑ Conventional
Other IE "Xo
Septic Tank: PL00 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of : r
Drainage Field
ditches
Z. of each ditch / feet
ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Ag t Date /Z
12-5-28591 (1) 12-5-28591 (3)
s
o
7
g
12-5-28591 (7)
12-5-28591 (8)
Jf : j
12-5-28591 (4) 12-5-28591 (5) 12-5-28591 (6)