OPHTE# fO- z~rr~i Harnett County Department of Public Health
PERMIT # X035 Operation Perms 21 71 4
LEI New Installation 12f Septic Tank VNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION::vf-1w3
Name: (owner) 5 W-r-t 3uz SUBDIVISION r". c LOT # ry~
! -
System Installer:y Registration #
Basement with plumbing: ❑ Garage 1212/ /umber of Bedrooms
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: & '"I Y'Des V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ims system has been mstaneo to compliance with applicable North Larohna General Statutes, Nules for Sewage Treatment and
and all conditions of the Improvement Permit and Construction Authorization.
311,
rct%m1 LununluN3:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewadisposal system on the above captioned property.,
Type of system: ❑ Conventional IJ Other 1t` 'D i'tO 5 XZT~ Lam` Septic Tank: T(pO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ^t of each ditch 60 feet ditches ~ feet ditches 411 inches
french Drain Required: Linear feet
Authorized State n Date J ~ 1'
4s
i
A4A&. Y
10-524101 (1)
10-524101 (2)
10-524101 (3)
10-524101 (4) 10-524101 (5)
10-524101(6)
10-524101(7)
10-524101(8)
10-524101(9) 10-524101(10)
no-
r
10-524101 (11)
10-524101 (12)
10-524101 (13)
10-524101 (14) 10-524101 (15)
10-524101 (16)
10-524101 (17)
10-524101 (18)
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