OPHTE# : :5 "3C tS Y Harnett County Department of Public Health 23787
PERMIT # 29 Y/ / CYdtlp0
12/New Operation Inst�allation EY�Septic Tank Ld' Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION:2�&dyo eA<1& -o to -9 k:.osJ
Name: (owner) /<rs Z) SUBDIVISION / ds LOT # Zi
System Installer: ( -; alt Registration #
Basement with plumbing: ❑ Garage �mber of Bedro ms
Type of Water SuQply: ❑ Community Public ❑ Well Distance from well feet
System Type: i7, L 5 `' 1tP f — % n Types V and VI Systems expire in S years.
(In accordance with T file V a) Ow er must contact Mealth Department 6 months prior to expiration for permit renewal.
LZc.rS"�
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.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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.
f
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional E�Other Z';' e> Septic Tank gallons Pump Tank / gallons
Subsurface No. of exact length width of depth of //�.a�
Drainage Field ditches 5 of each ditch 7`0 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Aged J^� / 4gAj n Ag_ — Date / 0 -/ 57— 1 Sr
15-5-36454 (1)
A' :4
15-5-36454 (6)
f �
15-5-36454 (2)
ONE
F
15-5-36454 (7)
15-5-36454 (3)
ro
4 I
15-5-36454 (4) 15-5-36454 (5)
15-5-36454 (8) 15-5-36454 (9)
15-5-36454 (10)
15-5-36454 (11) 15-5-36454 (12) 15-5-36454 (13) 15-5-36454 (14) 15-5-36454 (15)
t n N
15-5-36454 (16) 15-5-36454 (17) 15-5-36454 (18) 15-5-36454 (19) 15-5-36454 (20)