OPHTE# f� -� -37$Sr Harnett County Department of Public Health 24044
PERMIT # Z$6g Z / Operation P mit
New Installation v❑ Septic Tank LJ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,-,- A3,t. ) 2a
Name: (owner) / s r -4 r -L, Jnz ky-vn� T -t c SUBDIVISION _4-12422el tozzY ,-s LOT # /37
System Installer. Registration #
Basement with plumbing: ❑ Garage 19( Number of Bedrooms 3
Type of Water Supply: ❑ Community Eg/Public ❑ Well Distance from well feet
System Type: ' G Types V and VI Systems expire in S years.
(In accordan�ydth Table V a) wrier must contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and construction Amhonzation
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PERMIT CONDITIONS
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 -Boz ❑ Pump ❑ Alarm ❑ H2O1-ine ❑
Following are the specifications for the sewaHe disposal system on the above captioned property.
Type of system: 11 Conventional C� Other 7-5% 2 fk)uT ri 5S ynf-q.- Septic Tank t c?o o gallons Pump Tank
Subsurface No. of exact length width of depth of
Drainage Field ditches ) of each ditch 3' o feet ditches feet ditches T
French Drain Reouired: Linear feet
Authorized StateneAt�i i �— I' �:—a �8� Date S ^ & -
Line
gallons
inches
15-5-37531 (1)
15-5-37531 (2)
15-5-37531 (3)
15-5-37531 (4)
i
15-5-37531(5)
15-5-37531 (6)
15-5-37531 (7)
15-5-37531 (6)
15-5-37531 (9)
15-5-37531 (10)
15-5-37531 (11)
15-5-37531(12)
15-5-37531(13)
15-5-37531(14)
15-5-37531 (15)