OPHTE#_�lv j Harnett County Department of Public Health 23886
PERMIT # % %Q Operation Pe it ��
EJ New Installation Septic Tank Nitrification Line ❑ RepairExp,
PROPERTY LKATIO03Z-1"74) 3 ZLMWa � �
Name: (owner) / .S'— o--AtO SUBDIVISION LOT #
System Installer: /0, Qom_ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms I—
Type of Water Supply: ❑ Community 2r Public ❑ Well Distance from well feet
System Type: nd VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
stem has been installed in comuliance with aooliable North Carolina General Strums, Rules for
N S Abr!� 1 11 Lc_—% o-0- —
son all fUamtlons or me mirrovement rermn ana lonaru[➢on
I. Performance:
If. 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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sew�6e disposal system on the above captioned property.
Type of system: ElConventional Other (Z34'su cx L, Septic Tank: I Z0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches feet ditches inches
French Drain Required: Linear feet
fI-22s-y 1.
Authorized State Attent (-- >!t CQA S Date
�.E� -_ i ! �IIIIIIIIIII IIf111N/1111 quWNI sA
15-5-37109 (1) 15-5-37109 (2) 15-5-37109 (3) 15-5-37109 (4) 15-5-37109 (5)
15-5-37109 (6) 15-5-37109 (7) 15-5-37109 (8) 15-5-37109 (9) 15-5-37109 (10)
15-5-37109 (11) 15-5-37109 (12) 15-5-37109 (13) 15-5-37109 (14) 15-5-37109 (15)
AZ
15-5-37109 (16) 15-5-37109 (17)