OPHTE# 16 s 397113 Harnett County Department of Public Health
PERMIT # ZS`' �} 24379
dation Permit
EFr New Installation 0--leptic Tank I(cation Line ❑ Repair ❑ WExpansion
!.�_L`' PROPERTY LOCATION: 5(L 16% 1 G \,1 -�
) X2d6 2
Name: (owner) �-�5}{y� /V[''7o;UA\ SUBDIVISION 1y:11o.a�\orObt- LOT #
System Installer: S 5;k;p c �W� Registration #
Basement with plumbing. ❑ Garage�u �f Bedrooms —
Type of Water Supply: ❑ Community 13�'Public _P_—W Distance from well feet
System Type: 25%v (/e-.1.u—,Ie—t aN Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed in mmphance with applicable North Carolina General Stati Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
7
r
r
Gbs
Ze`A
ao`
I S
car
I S
2Yt 3612
S r ej ZVs
W
C so lb e
t
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No IV
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sewa uposal s stem on the above captionedpfroperty.
Type of system: ❑ Conventional Other 9 Delo k6 6- Y% 01 Septic Tank gallons Pump Tank gallons
Subsurface No. of r7 exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches feet ditches22 'L f inches
French Drain Reunited: Linear feet
Authorized State Agefst a % O ' c Ji f r Date -�7 ' I
16-5-39243 (1)
16-5-39243 (2) 16-5-39243 (3) 16-5-39243 (4)
16-5-39243 (5)
16-5-39243 (6)
16-5-39243 (11)
16-5-39243 (16)
16-5-39243 (7) 16-5-39243 (8)
16-5-39243 (9) 16-5-39243 (10)
16-5-39243 (12) 16-5-39243 (13)
16-5-39243 (14) 16-5-39243 (15)