OPHTE# 1�'-S'-3'1Z3d Harnett County Department of Public Health 24243
PERMIT # ZQs4v 0 eration Per It
2/New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: d3Cie)Xff-1190A� ;7L
Name: (owner)--15rN6(S X I IM -S SUBDIVISION ?&x& LOT # .34
System Installer. 5f JDk Registration #
Basement with plumbing: ❑ Garage � umber of Bedrooms
Type of Water Supply: ❑ Commum L9 Pub is ❑ Well Distance from well feet
System Type: Z r Rp,br) r .ai. f uY CZ Types V and VI Systems expire in 5 years.
(In accordance with Table V a) A Owner must con ct Health Department 6 montIs
prior to expiration for permit renewal.
This system has been installed in compliance wish applicable North Cars General Statutes, Rules for Sewage Treatment and Disposal, and all conditof the Improvement Permit and Construction Authorization.
I. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
Other.
I-
udauf Q
LN
ZIP
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.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for the se;wal disposal
system on the above captioned property.
Type of system:
ElConventional Other Z -401b
Z i
Septic Tank: (00`6 gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of 4
ditches 1
exact length
of each ditch 616 feet
width of2 depth of
ditches J feet ditches inches
trench Drain Required: Linear feet
Authorized State ent Date
15-5-37230 (1) 15-5-37230 (2) 15-5-37230 (3) 15-5-37230 (4) 15-5-37230 (5)
i
15-5-37230 (6) 15-5-37230 (7) 15-5-37230 (8) 15-5-37230 (9) 15-5-37230 (10)
15-5-37230 (11) 15-5-37230 (12) 15-5-37230 (13) 15-5-37230 (14) 15-5-37230 (15)
mmmS.
155-37230(16) 15-5-37230(17) 15-5-37230(18) 15-5-37230(19) 15-5-37230(20)
15-5-37230 (21) 15-5-37230 (22)