OPHTE# qbl (, Harnett County Department of Public Health 24496
PERMIT # U733y /0 eration Per t /
ra' New Installation Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONftW.0 /F�"IG Js /la1
Name: (owner) Zx A- l &4E.,n.- /&►'9G !►,ca, SUBDIVISION A7XZ $ LOT # .3_
System Installer: Registration #
Basement with plumbing: ❑ Garage Ed umber of Bedrooms
Type of Water Supply: D Community Lvl Public El Well Distance from well feet
System Type: S17z eai. G GZLAItoess V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Qlth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PtNMII LUNUIIIUNY
I. Performance:
IL Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
1
t
a $e
Li
e t6
0
GS—
t^> 3b
Vi
S7cae-T-
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 ❑
Following are the specilications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Required:
Authorized State
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewa disposal s stem on the abov captioned p
roperty.
gtOther l't; Septic Tank I LM gallons Pump Tank: gallons
exact length width of depth of
Of feet ditches feet ditches 68" inches
Linear feet
Date " Z — �l
17-540976 (1) 17-5-40976 (2) 17-5-40976 (3) 17-5-40976 (4) 17-5-40976 (5)
17-5-40976 (6) 17-5-40976 (7) 17-540976 (8)