OPHTE#.� �-1�z5o� Harnett County Department of Public Health 24042
PERMIT# Zg",? Operation Per It
EJ New installati c Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO STV /2/ aAr1111111ZGf iZ6
Name: (owner)�,.� z SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms 3
Type of Water Suppl : ❑ Community 1�ublic El Well Distance from well feet
System Type: Z�IIWZ�* LSl[11 S-_7si,} Tw� 3 le" -"47 Types V and VI Systems expire in S 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 Authoritarian
PERMIT CONDITIONS
I. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
Other.
v
1
v
.SCG i�14 rh...,•� v pc.u+,,w�H rtla
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 ❑ Alorm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sew a disposal system on the above captioned property.
Type of system:
❑ Conventional
i Other 2i°/p 0, c613 LT! 0i Septic Tank: 1606
gallons Pump Tank gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
5
of each ditch feet ditches
feet ditches 27 r s inches
French Drain Required: Linear feet
Authorized State Ag L; ZM�,, f! _ Date S Z 1 (0
08-5-19509 (1)
08-5-19509 (6)
08-5-19509 (2)
08-5-19509 (7)
08-5-19509 (3)
08-5-19509 (8)
08-5-19509 (4)
08-5-19509 (5)
08-5-19509 (9)
08-5-19509 (10)