OP RHTE# /1-5— yZ//ijl2 Harnett County gDepartment of Public Health 24792
PERMIT # R QrdUion Per
Newew Q
Installation r Septic lank Nitrification Line ❑ Repair ❑Expansion
PROPERTY LOCATIONt (1ge'o' 45,*�?=r1
Name: (owner) t SUBDIVISION LOT # L
System Installer: Registration #
Basement with plumbing: ❑ arage ember of Bedrooms
Type of Water Supp . ❑ Commumb Publi�j ❑ Well Di ace fr m well feet
System Type: �o /7e Z Sh) / ALO �1 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner )m contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statuses, Ad4Sfor Sewage easment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal s stem on the abov captioned property.
Type of system: ❑ Conventional Other,_ Septic Tank: !ldU�ir� gallons Pump Tank: % 0�gallons
Subsurface No. of exact length rI 77 �'�l width of depth of a
Drainage Field ditches 14 of each ditch feet ditches feet ditches /0 inches
French Drain Required: Linear feet
Authorized State Aglei Date 2
17-5-42114R (1)
17-5-42114R (2)
17-5-42114R (7)
17-5-42114R (3)
17-5-42114R (8)
17-5-42114R (11)
17-5-42114R (12) 17-5-42114R (13)
A
17-5-42114R (4)
17-5-42114R (9)
17-5-42114R (14)
17-5-42114R (5)
i.
17-5-42114R (10)
i
i
17-5-42114R (16) 17-5-42114R (17) 17-5-42114R (18) 17-5-42114R (19) 17-542114R (20)
17-5-42114R (6)
17-5-42114R (2)
17-5-42114R (7)
17-5-42114R (3)
17-5-42114R (8)
17-5-42114R (11)
17-5-42114R (12) 17-5-42114R (13)
A
17-5-42114R (4)
17-5-42114R (9)
17-5-42114R (14)
17-5-42114R (5)
i.
17-5-42114R (10)
i
i
17-5-42114R (16) 17-5-42114R (17) 17-5-42114R (18) 17-5-42114R (19) 17-542114R (20)