OPHTE# /3 - 5 -32'5"7 Harnett County Department of Public Health
PERMIT # 2158( /Operation Pe It 22983
[13 New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:5C_ /.566 Fes, 2A
Name: (owner) �� �'/� ����� SUBDIVISION LOT #
System Installer: �«�,/ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 47-1W
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: Z_S% tOQVtZ241-� T rt G Q'z 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 larohna beneral )tatutes, Hules for sewage treatment ana umsposai, ana an conammns of me improvement rermit ana Lonstrucuon Numonzaaan.
C"X S W r44
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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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.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Er Other ).S °!a 2,<Wclbr- i S,Sfa Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z- of each ditch S D feet ditches feet ditches 2q r inches
French Drain Reouired: Linear feet
Authorized State Agedt —� /'� Date f D — ► t — I
13 -5 -32157 (1)
13 -5 -32157 (2)
13 -5 -32157 (3)
13 -5 -32157 (4)
13 -5 -32157 (5)
13 -5- 32157(6)
13 -5 -32157 (7)
13 -5 -32157 (8)
13 -5 -32157 (9)
13 -5 -32157 (10)