OPHTE#—/ '/- 6 -7 i Harnett County Department of Public Health
23100
PERMIT # ct Operation P�ermiitt
New Installation E Septic Tank K�'Iitrific tion line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /1,14- ,l✓ts9 e?
Name: (owner) �.v: L�',a5 a. SUBDIVISION LOT #
System Installer: G e,.Jcd Te.f(e Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms �2.
Type of Water Supply: ❑ Community [Public ❑ Well Distance from well feet
System Type: C, Types V 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.
ims system nas peen mstauea in compuance wttn appucaole north larolma beneral Ntatutes, Rules for Sewage treatment and Disposal, and all conditions of the
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I. 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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewn p disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other f2-H--2 Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch /00 feet ditches _
French Drain Required: Linear feet
Ap =- -
14
Permit and Construction Authorization,
H2O1-ine ❑
PWR line
cs0 gallons Pump Tank: gallons
depth of
feet ditches /0-- 18 inches
Authorized State ARent�� ..�� �� Date 5`e /a�/S�
141-5-- 3 63/