OPHTE# i� `5�Z�Harnett County Department of Public Health 23612
PERMIT # - eration Pe it
New Installation Septic Tank IZ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,C,/N/.5`
Name: (owner) — c. SUBDIVISION rr--) LOT # YZ
System Installer: sQ S Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well feet
System Type: 391 / '+' s� G Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must con, ealth D m$nt 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sew reatment and Disposa, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V Othar-
V ��Jrf 305
.goyL
ltz�'
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 ❑
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other ,f'S°/a171iU Septic Tank: R a q
Subsurface No. of exact length width of
Drainage Field ditches 3 of each ditch g 0 feet ditches
French Drain Required: Linear feet
Authorized State ent � — Z Date
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches }IL9 inches
0-'2!8-15'
15-5-36027 (1)
15-5-36027 (2)
15-5-36027 (3)
15-5-36027 (4)
15-5-36027 (5)
15-5-36027 (6)
15-5-36027 (11)
15-5-36027 (7)
15-5-36027 (8)
15-5-36027 (9)
15-5-36027 (10)