OPHTE# =� L LL Harnett County Department of Public Health
23175
PERMIT # Z7 5 '7 -7 0 eration Per ait
L:New Installation Septic Tank [R- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: q69 6 , tr ► y 4�a•s
Name: (owner) SUBDIVISION r- LOT #
System Installer: 12g �. r°f {° Registration
Basement with plumbing: ❑ Garage 2' Number of Bedrooms `°1
Type of Water Supply: ❑ Community e �,ublic ❑ Well Distance from well feet
System Type: 2 S + '26'k�'U ,5 {°9_ 1 U .,t! c% C 2 et Types V a d VI Systems expire in 5 years.
(In accordance with Table V a) 0 ` ' rle rtment 6 months prior to expiration for permit renewal.
This system has been installed in compliance with aoDlicable N rth Carolina Gener, St es. Rul�Treatment DisD al, and all conditions of the Imorovement Permit and construction Authorization.
I
I f G) ctrl Zr C;,% N/
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 seewwa a disposal system on the above captioned property.
Type of system: El Conventional Lfi Other25�ti `26 - -Vs,, Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 Zo feet ditches 13 feet ditches A-21 inches
French Drain Required: linear feet
Authorized State A9W Date
i
13 -5 -32091 (1)
13 -5 -32091 (2)
13 -5 -32091 (3)
13 -5 -32091 (4)
13 -5 -32091 (5)
13 -5 -32091 (6)
13- 5- 32091(11)
13 -5 -32091 (7)
13 -5 -32091 (8)
13 -5 -32091 (9)
13 -5 -32091 (10)