OPHTE# :--5= Harnett County Department of Public Health
PERMIT #_ Operation Per It 2 2 6 7 5
2 New Installation Seatic Tank a Nitrifcation Line ❑ Reaair ❑ Exuansion
PROPERTY LOCATION -_)9 —r ci' 12
Name: (owner) 11144 6 SUBDIVISION JOT #
System Installer: _ P Registration #
Basement with plumbing: ❑ Garage mber of Bedrooms
Type of Water Supply: El Community Public ❑ _Well Distance from well feet
System Type: p ! %, l fig es V and VI Systems expire in 5 years.
(In accordance with The V a) Owner must co ealth Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance:
11. 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 sewo disposal system on the above captioned property.
Type of system: ❑ Conventional Other ?am„ r,L- Z " i ZAbQ "�°`-- Septic Tank: l gallons Pump Tank: 100 gallons
Subsurface No. of � I exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches ZqZ Z - inches
French Drain Required: Linear feet
Authorized State Age Date _ `��
v.
v �
i
Ham.
13 -5 -30656 (1)
13 -5 -30656 (2)
13 -5 -30656 (3)
13 -5 -30656 (4)
13 -5 -30656 (5)
4 P
d '
13 -5 -30656 (6)
13 -5 -30656
(7)
13 -5 -30656 (8)
13 -5 -30656 (9)
13-5-30656(10)
t .n
11
t
n'
w
v
iv
l r
"Ing
13-5-30656(11)
13 -5 -30656 (12)
13-5-30656(13)
13 -5 -30656 (14)
13 -5 -30656 (15)
J S
u,
13 -5 -30656 (16)