OPHTE# t t-s—ub�� s Harnett County Department of Public Health 24370
PERMIT# Z5I �3 /0 eration Pe It
�a' New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO[ATIONY/6-(/7 G9wro-JO eA
Name: (owner)zlcy , .B '15 SUBDIVISION LOT # Q—
System Installer S s - - 's;*z'cn.. Registration #
Basement with plumbing: ❑ Garage��umber of Bedrooms 3
Type of Water Supply: ❑ Community LAS Public ❑ Well Distance from well feet
System Type: %Types V and VI Systems expire in S years.
(In accordance with Table V a) wner must co t e ep onths prior to expiration for permit renewal.
This system has been installed in comoliancelyth aooliable North rarolina General
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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 ❑
11201-ine ❑ PWR Line
Following are the
specifications for
the sew a disposal system on the above captioned prope
Type of system:
EJ Conventional
Other 25%/llsieiF.►Septic Tank: 1000
gallons Pump Tank: gallons
Subsurface
No. of
exact length t width of
depth of
Drainage Field
ditches
of each ditch t eo feet ditches
feet ditches 22--'y I inches
hrench Drain Required: -Linear feet �1
Authorized State Ag C___ 2 Date �' J-7 ft7j__
vti
17-5-40653 (1) 17-5-40653 (2) 17-5-40653 (3) 17-5-40653 (4) 17-5-40653.(5)
f
17-5-40653 (11) 17-5-40653 (12) 17-5-40653 (13) 17-540653 (14) 17-5-40653 (15)
- cq¢
3
17-5-40653(16) 17-5-40653 (17) 17-5-40653 (18)