OPHTE # Harnett County Department of Public Health 23479
PERMIT # %7 g 53 /Operation Pe it /witrification d New Installation Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOCATION;,!,5w-//,/37
Name: ( owner) _5 i t cQ�.f_s r.jc. SUBDIVISION A LOT # `O
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community P5'-Public ❑ Well Distance from well feet
System Type: /a r -1' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Ow er mus�,contact Health Department 6 months prior to expiration for permit renewal.
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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 Authorization
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I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ H2O1-ine ❑
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other vn —%h 2.,5- LJc.,®"7t/1—. Septic Tank: /a®° gallons Pump Tank:
Subsurface No. of &act length width of depth of
Drainage Field ditches J of each ditch 3 feet ditches 2� .,
g _� feet ditches
French Drain Required: Linear feet
Authorized State
Date 16 -2 s - /v1
PWR Line
gallons
inches
14 -5- 33197(2)
14 -5 -33197 (3)
14 -5 -33197 (4)
14 -5 -33197 (5)
14 -5 -33197 (6)
14 -5- 33197(7)
14 -5 -33197 (1)
14 -5 -33197 (8)
14 -5 -33197 (9)
14 -5 -33197 (10)
14 -5 -33197 (11)