OPHTE# Ls- - psi Harnett County Department of Public Health 23893
PERMIT # 2e-5-72- ,0 eration Per '
New Installation eSepticTank ff Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOfATION:zpyyy7/L-z -/s U✓/ -5 ic-4
Name: (owner) Q — �� SUBDIVISION /!/l rc v/r e-G,.c.> f- LOT # /_
System Installer: Get w Registration #
Basement with plumbing: ❑ Garage�/�umber of Bedrooms '�-
Type of Water Supply: ❑ Community Ld Public ❑ Well Distance from well feet
System Type: % Rgf>- stcJ sV —'L ypes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact ealth Department 6 months prior to expiration for permit renewal.
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ M20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 13 Other LS %s'& c' -U -Ll 4,1S 4a— Septic Tank: I uc� b gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3"c' feet ditches -3 feet ditches 2y'>18 inches
French Drain Required: Linear feet
Authorized State AF 6t s S /4,'Z'�— s' Z- Date I - 21-1 b
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15-5-35981 (16) 15-5-35981 (17) 15-5-35981 (18) 15-5-35981 (19) 15-5-35981 (20)
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15-5-35981 (21) 15-5-35981 (22) 15-5-35981 (23) 15-5-35981 (24) 15-5-35981 (25)
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15-5-35981 (26) 15-5-35981 (27)
15-5-35981(1)
15-5-35981 (2)
15-5-35981 (3) 15-5-35981 (4)
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15-5-35981 (6) 15-5-35981 (7) 15-5-35981 (8) 15-5-35981 (9) 15-5-35981 (10)
15-5-35981 (11) 15-5-35981 (12) 15-5-35981 (13) 15-5-35981 (14) 15-5-35981 (15)
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15-5-35981 (16) 15-5-35981 (17) 15-5-35981 (18) 15-5-35981 (19) 15-5-35981 (20)
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15-5-35981 (21) 15-5-35981 (22) 15-5-35981 (23) 15-5-35981 (24) 15-5-35981 (25)
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15-5-35981 (26) 15-5-35981 (27)