OPHTE# 37ZIl Harnett County Department of Public Health 23904
PERMIT # 279-5-7/ i, Operation /witrification
NewwInstallation �' Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONdy( jft, 22WSLfA
Name: (owner) 7�u (% Cs islt�G��v�L SUBDIVISION/J�Ki / LZ_ , tre LOT # 17
System Installer:Registration #
Basement with plumbing: ❑ Garage A Number of Bedrooms
Type of Water Supply: ❑ Community If Public ❑ Well Distance from well feet
System Type: % r7G. avcrr af- G�Z Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner a nt 6 months prior to expiration for permit renewal.
This system has been installed in compliance with aoolicable North Cardlina General Sutures. Rules for
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
ZS! o
MI
I'v
and all conditions of the
4
� 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.
Permit and construction Authorization.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for
the sew a6M disposal system on the above captioned property.
Type of system:
❑
ther
Septic Tank: o gallons
Pump Tank gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
3 of each ditch /00 feet
ditches 3 feet
ditches inches
French Drain Required: Linear feet L
Authorized State Age � i �Date Z — / I)—
v / (o
15-5-37211 (1)
15-5-37211 (2)
15-5-37211 (3)
15-5-37211 (4)
15-5-37211 (5)
15-5-37211 (6)
15-5-37211 (11)
15-5-37211 (7)
15-5-37211 (8)
15-5-37211 (9)
15-5-37211 (10)