OPHTE# /q--5--3ytfr Harnett County Department of Public Health 23514
PERMIT # ?--79 Operation le mit
New Installation Septic Tank VNItrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION / /s N�.,r1ls
Name: (owner) SUBDIVISION LOT #
System Installer:`moi _ //D'�1�� �K Registration #
Basement with plumbing: ❑ Garage ❑ Number Bedrooms 73
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Z5'Y fLBDpcstry. �f�, _.. 7,,Lz,, rcr n2 L-� 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 General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtKNII LUNDIIIUNS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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Y
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V
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.
❑
D -Box ❑
Pump ❑
Alarm ❑
Following are the specifications
for the sewage
disposal system on the above captioned property.
Type of system: El
Conventional L_1,Other
Z5%9j2, 0 crL.-_
Septic Tank: /
Subsurface
No. of
exact length
width of
Drainage Field
ditches Z-
of each ditch f feet
ditches 3
French Drain Required:
Linear feet
H2O1-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches Zo 7 t; inches
Authorized State Aggnt � 2 Date S — /s
t
r y,
ti
14-5-34055 (6)
14-5-34055 (7) 14-5-34055 (8)
14-5-34055 (9)
14-5-34055 (10)