OPHTE# s5 Harnett County Department of Public Health 23796
PERMIT # ZSy 6 3 / 0 eration Per 't
Q New Installation Septic TankNitrification Line ❑ Repair ❑ Expansior
PROPERTY LOICATION:
Name: (owner) � /�i1h 4'71n1e- SUBDIVISION .¢✓ :>il LOT # Z
System Installer: %Z dss az 2e P h v ;I.i! — Registration #
Basement with plumbing:
El ber o Bedrooml s
Type of Watersapply: ❑ Community Public ❑ Well Distance from well feet
System Type: -!:rTypes V and VI Systems expire in 5 years.
(In accordance with Tae V a) Owner s'th Department 6 months prior to expiration for permit renewal.
vz rrx. y
North Carolina General SI
17 Ila'
PERMIT CONDITIONS:
I. Performance: System shall perform in ascot
ll. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961,0
Subsurface system operator rt
If yes, see attached sheet for
IV. Operation:
V. Other.
Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
P
L2
Yes ❑ No ❑ w
sal operation conditions, maintenance
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewagp, disposal system on the above captioned property.
Type of system: ❑ Conventional Other 7t ...n {e ZT 5PA jZ"CX41 % Septic Tank:�� d gallons Pump Tank: /060 gallons
Subsurface No. of �,/ It exact length / width of depth of
Drainage Field ditches / of each ditch c¢6 feet ditches 3 feet ditches 4� inches
French Drain Reauired: Linear feet
Authorized State heed'— <� /Y�/�. �— �`— Date /0 — /5— —/S—
15-5-36453 (6) 15-5-36453 (7) 15-5-36453 (8) 15-5-36453 (9) 15-5-36453 (10)
15-5-36453 (11) 15-5-36453 (12) 15-5-36453 (13) 15-5-36453 (14) 15-5-36453 (15)
7
q--
15-5-36453 (16) 15-5-36453 (17) 15-5-36453 (18) 15-5-36453 (19) 15-5-36453 (20)