OPHTE# _ 5--Z(,415 Harnett County Department of Public Health
PERMIT # Z? , L/ & Operation Perwilt 21724
❑ New Installation I!1 Septic Tank L~J Nitrification Line ❑ Repair Q( Expansion
PROPERTY LO(ATION:_5&yQ-S if ~ ,2t)
Name: (owner) A, 444, j y' Ce,% 05~ C ~i SUBDIVISION LOT #
System Installer: 245,-n3 f' Registration #
Basement with plumbing: ❑ Garage El mber of Bedrooms
Type of Water Supply: ❑ Community Lr Public ❑ Well Distance from well feet
System Type: 25` RA&P J 070- y Z'y,;f1e fs Zt +ry Types V and VI Systems expire in 5 years.
(In accordance with Table V a) t Owner must contact Health Department 6 months prior to exQiration for permit renewal.
This system has been installed in compliance with applijable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, an " ns of the Impr4ement Permit and Construction Authorization
❑
D-Box ❑
Pump ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal stem on the above captioned property.
'
Type of system:
❑ Conventional ❑
~
Other lal=1}C !
Septic Tank: b 0 O gallons Pump Tank: gallons
Subsurface
No. of
3
exact length
width of depth of
Drainage Field
ditches -
of each ditch 0 feet
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Ag Date 3r 23
HTE# - - Z&0jai Permit # I (e4 l k
Harnett County Department of 1'ublic Health
Site Sketch
PROPERTY LOCATON: 2~~3
ISSUED TO:; U-4-e-l 4- -&-Jr-4 ~7-&w S SUBDIVISION LOT #
Authorized State A
S Date:. ..2 - 2'd
0
5~
N r-
~ Sao
40
t
t j6
*1-050
4
" Z 1463 Kc, F,..,5 20