OPHTE#jS-s -371L7 Harnett County Department of Public Health 24050
PERMIT # LB �&5_ 0 eration Permit
Ca New 'Installation Tank d Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION:T?,-4 .37 64U -a -L -Q /eb
Name: (owner) ST/ T y Z3tO DA2,4 SUBDIVISION Iir1!k( ZzJ& LOT # is�C
System Installer: Sr73-r1c=4 /fit Registration #
Basement with plumbing: ❑ Garage�� umber of Bedrooms 3
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: 7W*to T v s V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Aalth 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 Authoriation.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional a Other Septic Tank: I s e D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches LA of each ditch ®00 feet ditches 3 feet ditches of inches
French Drain Required: Linear Leet
Authorized State A Date 4-1—A.
-'y%
15-5-37169 (1)
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15-5-37169(18)