OP RHTE# 14n-s—'40rz5?3a Harnett County Department of Public Health 24502
PERMIT # 201 119 Operation Pe It
L✓ New Installation Septic Tank p Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOfATION:az_i77aS 6 i /) r � d2D
Name: (owner)�urt �,g, ti 31 D (ate k 1-d,,_SUBDIVISIONc ,r x� LOT # I
System Installer. Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms 3
Type of Water Supply: 13Community Public ❑ Well Distance from well feet
System Type: s CtSt lf�ZT Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Own r nual con&R Health 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 Commission AWiviniation
r
36 M t"i It f2
to
5 13
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h 3
5 W
PERMIT CONDITIONS: 7 V i
renormance: system snan penorm In accordance with Rule .I vol.
Monitoring: As required by Rule .1961.
Subsurface system operator r cored? Yes ❑ No ❑
If yes, see attached sheet In additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OUne
❑ PWR Line
Following are the
specifications for
the sevait disposal system on the above captioned property.
Type of system:
❑
Y Other 7K l "7>ur tl�t4�;,r-
_ Septic Tank: L76®. gallons
Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
Z exact length
3 of each ditch / oo feet
width of
ditches feet
depth of
ditches Zq inches
French Drain Required: Linear feet
Authorized State A nt 2 Date
NOON=
16-540073R (1) 16-5-40073R (2) 16-5-40073R (3) 16-540073R (4) 16-540073R (5)
s- ..
16-5-40073R (6) 16-5-40073R (7) 16-5-40073R (8) 16-5-40073R (9) 16-5-40073R (10)
i
• Y` a
16-540073R (11) 16-5-40073R (12) 16-5-40073R (13) 16-540073R (14) 16-540073R (15)
Wmo,N"
16-5-40073R (16) 16-5-40073R (17) 16-540073R (18) 16-5-40073R (19) 16-540073R (20)
MM -
16 -5-40073R (21) 16-540073R (22)