OPNTE #1y -r- _V1Q6 Harnett County Department of Public Health
PERMIT # Z3o sy 0 eration Per et 23471
12' New Installation E3" Septic Tank L'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION- J4
p
Name: (owner) rl // W asc.�l SUBDIVISION t LOT #
System Installer: 4Z71 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrr ms 2
Type of Water Supply: El Community El Public Q' Well Distance from well feet
System Type: d` r2gft C� ►Qz Types V and VI Systems expire in 5 years.
(In accordance with cable V a) I Owner must contact Health Department months prior to expiration for permit renewal.
This system has been installed in compliance with applicabl North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
s � h
PERMIT
I.
II.
III. i
IV.
V
X
Following 'ore
Type of systen
Subsurface
Drainage Field
French Drain I
t�
It
'0\$ i
.x�
t nu9
System shall perform in accordance with Rule .461.
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 ❑ Alarm ❑
specifications for the seewwa disposal system on the above captioned property.
El Conventional Ld' Other �'S °6/L"iJ0 Septic Tank:
No. of exact length width of
ditches 2 of each ditch /00 feet ditches
!ired: Linear feet
1-1201-ine ❑ PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches f inches
Authorized State A 'nt k� /�����,� " Date
s
14 -5- 34196(2)
14 -5 -34196 (3)
14 -5 -34196 (4)
14 -5 -34196 (5)
14 -5 -34196 (6)
14 -5- 34196(7)
14 -5 -34196 (8)
14 -5 -34196 (9)
14 -5 -34196 (10)
14 -5 -34196 (1)