OPHTE# iS' S —q(Harnett County Department of Public Health 24040
PERMIT # 2 8S9 0 eratlon NMI
1New Installation c Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION -/Vyg 124
Name: (owner) �o.�v 5¢�^�� SUBDIVISION LOT # 1
System Installer. ' I-3 so-Gl +"JI ra s Registration #
Basement with plumbing: ❑ Garage Oumber of Bedrooms 3
Type of Water Supply: ❑ Community 9 Public ❑ Well Distance from well feet
System Type: ASO, -r5,= r3Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner m ac—B&P Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Wes for Sewage Treasonous and Disposal, and all conditions of the Improvement permit and Construction Authorization
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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 ❑
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional ;Other 7VI6n6Ju '1—rl— Septic Tank: f000
Subsurface No. of exact length / o width of
Drainage Field ditchesS� of each ditch _ feet ditches
1-12O1-ine ❑
PWR Line
_ gallons Pump Tank y e� gallons
depth of
feet ditches zo •'� rb inches
French Drain Required: Linear feet
Authorized State Ac= it+P> JS Date
15-5-37396 (1) 15-5-37396 (2) 15-5-37396 (3) 15-5-37396 (4) 15-5-37396 (5)
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15-5-37396 (6) 15-5-37396 (7) 15-5-37396 (8) 15-5-37396 (9) 15-5-37396 (10)
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15-5-37396 (11) 15-5-37396 (12) 15-5-37396 (13) 15-5-37396 (14) 15-5-37396 (15)
15-5-37396 (16) 15-5-37396 (17) 15-5-37396 (18) 15-5-37396 (19) 15-5-37396 (20)
15-5-37396 (21) 15-5-37396 (22)