OPHTE# /Z - S - 2�5j
Harnett
County Department of Public Health
PERMIT # Z!2 !s"
Operation PeIM
/wItrification
22480
C New Installation 5 Septic Tank Line
❑ Repair ❑ Expansion
PROPERTY LOCATION: 5gLIMc ,r.
-
Name: (owner)
SUBDIVISION ; � A�
LOT # 2
System Installer: PA466,-a
Registration #
Basement with plumbing: ❑ Garage
Number of Bedrooms 3
Type of Water Supply: ❑ Community
1Public ❑ Well Distance from well feet
System Type: 2S Z YU P YC.l7D&
% ; fir 5 k ,- I �
A Z5 6 and VI Systems expire in 5 years.
(In accordance with Table V a)
Owner must contact Health Department 6 months prior to expiration for permit renewal.
Gi u.vj- -q
PERMIT LUNUIIIUN):
I. Performance:
II. 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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew�ge disposal system on the above captioned property.
Type of system: ❑ Conventional ® Other 7;'/ -, 37 cif Li -2r�- . 5 �. - Septic Tank: It; C gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches G -2 ! ° inches
French Drain Reauired: Linear feet
Authorized State he t _- ' Date
12 -5 -29938 (1)
12 -5 -29938 (2)
12 -5 -29938 (3)
12 -5 -29938 (4)
12 -5 -29938 (5)
12 -5 -29938 (6)
12 -5 -29938 (7)
12 -5 -29938 (8)
12 -5 -29938 (9)
12 -5 -29938 (10)