OPHTE# IV 341�Z Harnett County Department of Public Health 23500
PERMIT # 28698 0 eration Per It /
New Installation Septic Tank /Nitrification Line ❑ Repair ❑ EXDansion
PROPERTY LOCATION VCI Lt I s'
Name: (owner) urs- 'c, SUBDIVISION :5 r'0q_-r—s-f..t LOT # t—f
System Installer:$ Registration #
Basement with plumbing: ❑ Garage �um er of Bedrooms _.-3
Type of Water Supply: ElCommunity LTJ Public ❑ Well Distance from well feet
System Type: Z.v--•_.. =_zl ac
— Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must con Health Department 6 months prior to expiration for permit renewal.
H C �f,►,-tea.
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
r�nrui wirunwn�.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
Y"
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1`
47
44'
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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 seewwa ee disposal
system on the above captioned property.
Type of system:
Eltional LOtConvenher Z5'°fa
f2161>V< y-_
Septic Tank: 100 D gallons Pump Tank: / 00 Z) gallons
Subsurface
Drainage Field
No. of
ditches
exact length b
of each ditch 60 feet
width of depth of
ditches _� feet ditches inches
French Drain Required: Linear feet
Authorized State Date
14-5-34942(1)
14-5-34942 (2)
14-5-34942 (3)
14-5-34942 (4)
14-5-34942 (5)
14-5-34942(6)
14-5-34942 (7)
14-5-34942 (8)
14-5-34942 (11) 14-5-34942 (12) 14-5-34942 (13)
14-5-34942 (9)
14-5-34942 (10)