OP R (2)HTE# J- S~ I~51 ~ Harnett County Department of Public Health 19972
PERMIT # `t 1 Qpefatl0n Pe(n
~ New Installation g Se tic Tank El Repair 9 Nitrification one ❑ Expansion
PROPERTY LOUITION: 1 A \
Name: (owner) SUBDIVISION C2'fY
LOT # -2
System Installer. Ie Q20K;Jr"-- Registration #
Basement with plumbing: ❑ Garage 9 Number of Bedrooms _ 3
Type of Water S ply ❑Community 9 Public ❑ Well Distance from well S J feet
System Type: -r, Z., C I-~ V- f z q aT 6> Types V and VI Systems expire in 5 years.
(In accordance with Table V al Owner must contact Health Department 6 months prior to expiration for permit renewal.
V. Other.
Following are the specifications for the sev~age dispos system on th above captioned property.
Type of system: ❑ (onventional Other L- Size of tank: Septic Tank: L)D 3_ gallons Pump Tank: '-~p J allons
Subsurface No. of exact length width of g
depth of
Drainage Field ditches of each ditch c c~ l feet ditches feet ditches- inches
French Drain Required: linear feet
Authorized State Agent 4 /1- l' -fyy Date 05- D " 0 ~r
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No ❑
It yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: