OPHTE# Il -5—
L" Harnett County Department of Public Health 23503
PERMIT # 27T5 Operation Pierit
L� New Installation Septic Tank L2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,Sj7_iV3-7 J ig GC J
Name: (owner) ,F�c1r�z SUBDIVISION LOT #
System Installer: 57-4>.r a Registration #
Basement with plumbing: ❑ Garage ��tuber of Bedrooms 3
Type of Water Supply: El Community Lvf Public ❑ Well Distance from well feet
System Type: Z5'-1'6 Cz Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta Health Department 6 months prior to expiration for permit renewal.
Ins 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
PERMIT CUNDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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 ❑
Following are the specifications for the sa disposal system on the above captioned property.
Type of system: Elewa Conventional Other 25%4�bo Zr Z --.fit,,
Subsurface No. of exact length
Drainage Field ditches ( of each ditch '"" feet
French Drain Required: Linear feet
Authorized State
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: ty gallons Pump Tank: gallons
width of depth of
ditches feet ditches l Y inches
Date a—i[6� `�