OPHTE #g� ' Harnett County Department of Public Health
PERMIT # erg ation Permit r 22976
New Installation Lei ZW5 Tank Nitrification Line ❑ Repair ❑ Ex ansior
P P
PROPERTY LOCATION:
Name: (owner) J41 -6 � — &AO SUBDIVISION LOT #
System Installer: 610 fi &; �- /_�r3� Registration #
Basement with plumbing: ❑ Garage ❑ knber of Bedrooms —R - j64r'Oh
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well feet
System Type: I iq--p "'a74 .r --,r— 13 Yys V and VI Systems expire in 5 years.
(In accordance with able V a) Owner must contact 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 Construction Authorization
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .196E
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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew a disp al system on the above captioned property.
Type of system: ❑ Conventional ( Other b )V " ZL Septic Tan iZi gallons Pump Tank: 00 li' gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches z of each ditch 70 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Age - - _ Date % c) — le —
13 -5 -31148 (1)
13 -5 -31148 (2)
13 -5 -31148 (3)
13 -5 -31148 (4)
13 -5 -31148 (5)
13 -5 -31148 (6)
13 -5 -31148 (7)
13 -5 -31148 (8)
13-5-31148 (9)
13 -5 -31148 (11)
13 -5 -31148 (12)
13 -5 -31148 (13)
13 -5 -31148 (14)
13 -5 -31148 (10)
Ellis Tew
C
Flow Tech Instillations
We the homeowners or owner agree's to The Instillation of Flow
Tech Septic Drain Lines for new or repared system.
Ins
v
1