OP RRNTE# fi-`S 2ibS.0 Harnett County Department of Public Health 23487
PERMIT # 24- 5_3D Operation Palm
New Installation Er Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONS rs'bY czl�sc� r
Name: (owner) us s /`% iZct c SUBDIVISION LOT # y
System Installer: J v,_� z.z� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: 701b rWrWe_.jn (7-2-n, 4—r—Ty t C>— e_ zt Types V and VI Systems expire in 5 years.
(In accordance with Table V a) i 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
Q
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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all conditions of the Improvement Permit and Construction Authorization.
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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.
0
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional Z Other
ZS%afZtDVtA_4--�,--S,404 Septic Tank: 1 omD
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches _
of each ditch °10 feet ditches 3
feet ditches 70 i g inches
French Drain Reauired:
Linear feet
Authorized State ent % ��ra N%'r �---"Date 2
11-5-27583R (1)
11-5-27583R (2)
11-5-27583R (3)
11-5-27583R (4)
11-5-27583R (5)
11-5-27583R (6)
11-5-27583R (7)
11-5-27583R (11)
11-5-27583R (12)
11-5-27583R (8)
11-5-27583R (9)
11-5-27583R (13)
11-5-27583R (14)
11-5-27583R (10)