OPHTE#1—.S—
PERMIT # 2-752-2—
Name:
5'3ZZ
Name: (owner)
System Installer:
Basement with plumbing: ❑
Type of Water Supply: ❑ Col
System Type:
(In accordance with TabP V a)
Harnett County Department of Public Health
24487
�6 eration Perm /
r�' New Installation Septic Tank r� Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATI0N1�ywt 6/�.-G.6 >S�-w„<, IE4
W-e� -X;uG . SUBDIVISION (::.—Z LOT # �o
Registration #
Garage C�}'/Mumber of Bedrooms
unity Public ❑ Well Distance tram well feet
— Types V and VI Systems expire in S years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
Cz .i ' Qor;4--- el
this system on been installed in mmphan<e with applicable Noah Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
I/r
Gai/e�-� lte3et�y
to
�?
, v
N�-, C.LcVj&' Lr
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 ❑ 11201-ine
❑ PWR Line
Following are the
specifications for the sewage disposal
system on the above captioned e .
Type of system:
❑ Conventional ❑ Other J.V �l.r<B
Septic Tank:O! U O gallons
Pump Tank C' gallons
Subsurface
Drainage Field
No. of
ditches I
exact length
of each ditch Z�kD feet
width of
ditches 3 feet
depth of pe
ditches �q inches
trench Drain Required: Linear feet
Authorized State Agent_'' �_,_� �� Date v��/�
r k�
17-5-40660 (1) 17-540660 (2) 17-540660 (3) 17-5-40660 (4) 17-5-40660 (5)
17-5-40660 (6) 17-5-40660 (7) 17-540660 (8) 17-5-40660 (9) 17-5-40660 (10)
iot
17-540660 (11) 17-5-40660 (12) 17-5-40660 (13) 17-540660 (14) 17-5-40660 (15)
17-540660 (16) 17-540660 (17) 17-540660 (18) 17-5-40660 (19) 17-5-40660 (20)
17-540660 (21) 17-540660 (22)