OPHTE# 5-7—S-'// 0 Harnett County Department of Public Health
24156
PERMIT # a 9453 Oaerftion Perm
New Installation Septic TankNitrl� ification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3s-+flbt,4�; 2d. SrZ. t 5! a
Name: (owner) SFu��.1 R -\a, c5 i„c SUBDIVISION ASS, ii ?mac¢, LOT # a
System Installer: ori Cilas Registration #
Basement with plumbing: ❑ Garage U. umb�ef Bedrooms —3
Type of Water Supply: ❑ Community [;-Iublic ❑ Well Distance from well ^'h feet
System Type: a 5 `" ft a J M 5 s . Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Own Gust contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nonh Carolina General Statutes, Rules for Sewage Treament and Disposal, and all conditions of the Improvement Permit and Constmaion Authorization.
a5�u M£Oucr'o a
'to;:PAr+ 4�a.�nc
G
sss $
342 szn
17ta
Ag4t"To,2 C'Lo4 Srt r$
�unm wnvnivna.
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 -Boz ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sewage dis sal system on the above captioned property.
Type of system: ❑ Conventional [her y" .Clp�'R'�—® Septic Tank: 1CXUC'� gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches a6
French Drain Required: Linear feet
Authorized State Agent Date cz,a I a,i I aot£°,
PWR Line
gallons
inches
c