OPHTE#5-73 -7 Harnett County Department of Public Health 24021
PERMIT # 2&58 / Operatic It
M New Installation 0 Septic Tank W Nitrification Line ❑ Repair ❑ Expansion
7Tt19d3111111111 EOI
Name: (owner) ! o f � ;*VL SUBDIVISION (�y,1oP.v.—✓'l�+c LOT # ,14
System Installer: M53eAl el ( Registration #
Basement with plumbing: ElGarage ,� /Number of Bedrooms --.5
Type of Water Supply: El Community LTJ Public ❑ Well Distance from well feet
System Type: 057')1Jxl� �-Tmes V and VI Systems expire in 5 years. 11--17
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expir for pe it renewal.
been insulted in compliance with applicable North Carolina General Statutes. Auks for Sewage Treatment and Dismsal. and all conditione—ol the Improvement Pernuf and Construction Authorization.
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
16'
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.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z>°/� (/(.r /nrl Septic Tank 0 0 o gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2> of each ditch 100 feet ditches � feet ditches Li inches
French Drain Required: Linear feet
I
Authorized State
Ageilt -z�' Date
15-5-37377 (1) 15-5-37377 (2) 15-5-37377 (3) 15-5-37377 (4) 15-5-37377 (5)
15-5-37377 (6) 15-5-37377 (7) 15-5-37377 (8) 15-5-37377 (9) 15-5-37377 (10)
15-5-37377 (11) 15-5-37377 (12) 15-5-37377 (13) 15-5-37377 (14) 15-5-37377 (15)
15-5-37377 (16) 15-5-37377 (17) 15-5-37377 (18) 15-5-37377 (19) 15-5-37377 (20)