OPHTE# It, 5-353 Zi
PERMIT # ? SS n
Name: (owner) /
System Installer: 6�
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type: 7526/ZgXJCi
(In accordance with Table V a)
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
in compliance with
Harnett County Department of Public Health 24331
/Operation Per it /
New Installation Septic Tank Ca' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 2��/or'�lw�,�& oro s,–ag���
� -�t!C, SUBDIVISION DXAi' 6U;9�0 S LOT #
i7= Registration #
Number of Bedrooms 3
Public ❑ Well Dis nrnhum weff- ------dee
Types V and VI Vs
Ow er must contact Health Departme
6 yc e
North Carolina General Statutes, ules for kwa¢e Treatment and Disposal, an
tems expire in S years.
6 months prior to expiration for permit renewal.
conditions of the Improvement Permit and construction Authorization.
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 ❑ H20Line ❑ PWR Line
Following are the
specifications for
ewa
the sa disposal system on the above captioned property.
Type of system:
❑ Conventional
Other Z50% f7Gnl)[JM'c><
Septic Tank 1600 gallons Pump Tank: 1 JOO gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
KJ of each ditch Cor feet
ditches feet ditches ZZ inches
trench Drain Required: Linear feet
. /j��—i��S
Authorized State Agent _.-a�--�� I Date /7 ' 29
L/
16.5-39321 (1)
16-5-39321 (6)
16.5-39321 (2)
16-5-39321 (7)
16-5-39321 (3)
16-5-39321 (8)
16-5-39321 (4)
16-5-39321 (9)
16-5.39321 (5)
16-5-39321 (10)
16-5-39321(11)
16-5-39321 (12)
16-5-39321 (16) 16-5-39321 (17)
16-5-39321 (13)
16-5-39321 (14)
16.5-39321 (15)