OPNTE#IS'S --US-g Harnett County Department of Public Health 23804
PERMIT # ZSN(vS �0 eration Per m*t
Ld New Installation Septic Tank Q'�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: %f coo _2D
Name: (owner) /9 SUBDIVISION 0S9o&,_-Q LOT # Z
System Installer. An Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type:%"es V and VI Systems expire in S years.
(in accordance with Table V a) _� Owner must contac!'�jealth Department 6 monthsapnor to expiration for permit renewal.
been installed in compliance with applicable North Carolina General Statutes. Rules for Sewace Treatment and Disposal, and
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
2N1Z I '
4v
o x Fo-4c2 r.J0,60 5
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.
the Improvement Permit and Construction
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewapAisposal system on the above captioned property.
Type of system: El Conventional EV
Other LSeptic Tank IgO6 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch ! Lc feet ditches feet ditches 29—)18 inches
French Drain Required: Linear feet
Authorized State nt Date
mom
15-5-36542 (1) 15-536542 (2) 15-5-36542 (3) 15-5-36542 (4) 15-5-36542 (5)
3
15-5-36542 (6) 15-5-36542 (7) 15-5-36542 (8) 15-5-36542 (9) 15-5-36542 (10)
ya
15-5-36542(11) 15-5-36542(12) 15-5-36542(13) 15-5-36542(14) 15-5-36542(15)
15-5-36542 (16) 15-5-36542 (17)