OPHTE# "j � - -rte Harnett County Department of Public Health
PERMIT # 51s'8 Operation Fierr .t 22681
I� New Installation L!f Septic Tank E7 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I-A-t 5=
Name: (owner) C &kLZ SUBDIVISION LOT # 2-7
System Installer: Registration #
Basement with plumbing: ❑ Garage 2INumber of Bedrooms
Type of Water Supply: ❑ Community EeK Public ❑ Well Distance from well feet
System Type: 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 Genet Statutes, Rules for Sewage Treatment and Disposal, and II conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 12"Other L &-- Septic Tank: 1 OTrb gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3-d feet ditches feet ditches 2 inches
French Drain Required: Linear feet
Authorized State A -� Date `�z
07 -5- 16959(1)
07 -5 -16959 (2)
07 -5 -16959 (3)
07 -5 -16959 (4)
07 -5 -16959 (5)
07 -5 -16959 (6)
07 -5 -16959 (7)
07 -5 -16959 (11) 07 -5 -16959 (12)
07 -5 -16959 (8)
07 -5 -16959 (9)
07 -5 -16959 (10)