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16--57-35435- HTE # I q — s5--3543.5HTE#1N— 17-- S`A-111 Harnett County Department of Public Health 23517 PERMIT # 2 9U 8 s /Operation Pe it © New Installation Septic Tank C>7 Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION: 5-4--1-ts 1 Lax, Pe - Name: (owner) /��v�� /� j—a-��dF SUBDIVISION L_LOT # i_ System Installer: weQ_V. -_ Registration # Basement, with plumbing: ❑ Garage f"Number of Bedrooms 3 Type of Water Supply: ❑ Community C2Public ❑ Well Distance from well feet System Type: Zsv 4i14,�t— Types V and VI Systems expire in 5 years. (In accordance with Table V a Owner m9t 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 alllconditions of the Improvement Permit and Construction Authorization. I IS PERMIT CONDITIONS: '. I. Performance: ,System shall perform in accot 11. Monitoring: required by Rule .1961. III. Maintenance: As required by Rule .1961. 0 Subsurface system operator rt, Ifl yes, see attached sheet for IV. Operation: V. Other: Rule .1961. ❑No❑ peration conditions, maintenance and reporting. ❑ D -Box ❑ 1 Pump ❑ Alarm ❑ _ Following are the specifications for the sewage disposal system on the above captioned property. Type of system: ❑ Conventional 52" Other Z's'/ r��t�t e -- Septic Tank: Subsurface No. of exact length width of Drainage Field ditches of each ditch 160 feet ditches _ N ne ❑ PWR Line / v v U gallons Pump Tank: gallons depth of feet ditches inches French Drain Required: Linear feet Authorized State Agen-- '' Date ? " t t r t i14 llifuY vi, �,' t 1 it s ro { w r tr k Afi, v v�� t tr. 14-5-34721 (16) 14-5-34721 (17)