OPHTE# )3- ,S--3)rn Harnett County Department of Public Health
PERMIT # 273 s'i 0 erp ation Permit 22991
L%f New Installation Septic Tank C?rNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /LD
Name: (owner) C:!--lam /h c, SUBDIVISION LOT #
System Installer: 2vsLev ?t„;!f Registration #
Basement with plumbing: ❑ Garage ,_../Number of Bedrooms IS
Type of Water Supply: El Community I� Public ❑ Well Distance from well feet
System Type: 2C0l. lZ4-6-a c4-ur— 5 f- c-.. -- T .1i G- hypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Own m t contact qVSK —Y 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 Fonditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS:
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 -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
E3- Other 2'5% Gtlx->_ Septic Tank: t o 0
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
3
depth of
Drainage Field
ditches
3 of each ditch 5 e feet ditches
feet ditches 20 inches
French Drain Required: Linear feet
Authorized State Age Date i C> --t,H—I 77
i
13 -5 -31179 (2)
13 -5 -31179 (3)
13 -5 -31179 (4)
13 -5 -31179 (5) 13 -5 -31179 (6)
13 -5 -31179 (7)
13 -5 -31179 (8)
13 -5 -31179 (9)
13 -5 -31179 (1)