OPHTE# /5Z-- Harnett founty Department of Public Health 23800
PERMIT # ZayA �peration Perwk'
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATIONoclae & aa4c 7n -ma /zip
Name: (owner) bwRYltc �� SUBDIVISION OXAtrZZ LOT # I_
System Installer: r.—i Registration #
Basement with plumbing: ❑ Garage�umber of Bedrooms _S
Type of Water Supply: ❑ Community IQ Public ❑ Well Distance from well feet
System Type: T Types V and VI Systems expire in S years.
(In accordance with Table V a) hs prior to expiration for permit renewal.
This system has been installed in compliance with applicable No"I Carolina General Statutes, Rules rol Sewage Treatment and Disposal, and all coni
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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑ 1-1201-ine ❑ PWR Line
Following are the
specifications for the
sew disposal system on the above captioned property.
Type of system:
❑ Conventional
Z Other ZS'/.R$J)vuLa. a I
Septic Tank 000 gallons Pump Tank: 0 o a gallons
Subsurface
No. of
3
exact length
SO
width of depth of
3
Drainage Field
ditches
of each ditch feet
ditches feet ditches inches
French Drain Required: Linear feet /
Authorized State Agetf��D --� �i4sY{7�wn Date % "G�
}
77
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15-5-36543 (1) 15-5-36543 (2) 15-5-36543 (3) 15-5-36543 (4) 15-5-36543 (5)
'JBeall
15-5-36543 (6) 15-5-36543(7) 15-5-36543(8) 15-5-36543(9) 15-5-36543(10)
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15-5-36543 (11) 15-5-36543(12) 15-5-36543(13) 15-5-36543 (14) 15-5-36543(15)
✓s `� `i r. I
15-5-36543(16) 15-5-36543(17) 15-5-36543(18) 15-5-36543(19)