OPHTE# / -3s73-7
Harnett County Department of Public Health
23618
PERMIT # -Z 6 3ep
ration Pe It
❑ New Installation Septic Tank Nitrification Line
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I3" Repair ❑ Expansion
PROPERTY LOCATION:/SLf2 ®�r� /3UT�'S CilP�l�rLS
Name: (owner) /%ZAn)� �'�i—.c_
SUBDIVISION
LOT #
System Installer:
Registration #
Basement with plumbing: ❑ Garage
O umber of�Bedr °ms
3 r
Type of Water Supply: El Community
Lei Public LTJ" Well
Distance from well Jb feet
System Type:$� iI -ZUC f
f
r — Types V and VI Systems expire in 5 years.
(In accordance with Table V a)
Owner mustcontact 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
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 0 Other Z'S -0/c, r447W L47� Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch /7-6 feet ditches feet ditches ZV inches
French Drain Required: Linear feet
Authorized State Ag t ! Date 7 — 30 /�
15-5-35737 (1)
15-5-35737 (2)
15-5-35737 (3)
15-5-35737 (4)
15-5-35737 (5)
15-5-35737 (6)
15-5-35737 (11)
15-5-35737 (7)
15-5-35737 (8)
15-5-35737 (9)
15-5-35737 (10)