OP RRHTE# 4���ze Harnett County Department of Public Health 23905
PERMIT # �0 eration Per It
r
Cta New Installation Ef Septic Tank EKNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOICATION: ZS>U 4 y S.2aaN%s City t[�t—�Cd❑
Name: (owner) cS��i�<fa4�I�E Gt4,2J SUBDIVISION LOT # 2—
System
System Installer: Tian n s Registration #
Basement with plumbing: ❑ Garageit umber of Bedrooms 3
Type of Water Supply: ❑ Community Id Public ❑ Well Distance from well feet
System Type: 5 v Types V and VI Systems expire in S years.
(In accordance with cable V a) Owner mus ct Health Department 6 months prior to expiration for permit renewal.
Ibis system has been installed in compliance with aolicable NorthfCarolina General Statutes. Rules for Sewaee Treatment and
1. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
6 �``Y j /° oF7�
and all conditions of the Improvement Permit and Construction
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 sewa a disposal system on the above captioned property.
Type of system: ❑ Conventional 70ther 1.9% arbOvTA'L'� Septic Tank: /ae b gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches d of each ditch z a O feet ditches 3 feet ditches Zq inches
French Drain Required: linear feet
Authorized State A9£lit �o — >__—�U�/h—,� Date Z -111"
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15-5-36627RR (1) 15-5-36627RR (2) 15-5-36627RR (3) 15-5-36627RR (4) 15-5-36627RR (5)
15-5-36627RR (6) 15-5-36627RR (7) 15-5-36627RR (8) 15-5-36627RR (9) 15-5-36627RR (10)
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15-5-36627RR (11) 15-5-36627RR (12) 15-5-36627RR (13) 15-5-36627RR (14) 15-5-36627RR (15)
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15-5-36627RR (16) 15-5-36627RR (17) 15-5-36627RR (18) 15-5-36627RR (19) 15-5-36627RR (20)