OPHTE# 13 3 Z4 !Z Harnett County Department of Public He It 23488
PERMIT # L."7 7 / i /Operation Pe et
d New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:& -15-7l C,i'se, 2®
Name: (owner) o 1/d- 11a -mss- , � SUBDIVISION LOT #
System Installer: ZL46 ni Registration #
Basement with plumbing: ❑ Garage 2", umber of Bedrooms
Type of Water Supply: ❑ Community ublic r El Well Distance from well feet
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System Type: C �}: rzzn — Zr 4 Types V and VI Systems expire in 5 years.
(In accordance with Table 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
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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 ❑ 11201-ine ❑ PWR Line
Following are the spe�' ations for the sewage disposal system on the above captioned property.
Type of system: EJr Conventional ❑ Other Septic Tank: jz>o c7 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 10 a feet ditches feet ditches 1 inches
French Drain Required: Linear feet
Authorized State ems„ t ,, i 1��^ Date
13-5-32691 (7)
13-5-32691 (6)
13-5-32691 (5)
13-5-32691 (4)
13-5-32691 (3)
13-5-32691(2)
13-5-32691 (1)
13-5-32691 (10)
13-5-32691 (9)
13-5-32691 (8)