OPHTEi#S'S —3-73ri
PERMIT #6(Z
Name: (owner)
System Installer:
Basement with plumbing: ❑
Type of Water Sup ly: ❑ Co
System Type: Z r!c
(In accordance with Table V a)
Harnett County Department of Public Health 24026
0 eratlon Per it
2/New installatio c Tank G2' Tication Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONdU1 ,/,
SUBDIVISION LOT # / 3
Registration
Garage R4umber A Bedrooms .3
unity Public ❑ Well Distance from well feet
U �— 2R,G V and VI Systems expire in 5 years.
Owner mustcontact Health Department 6 months prior to expiration for permit renewal.
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 ❑ 1120Line ❑
Following are the specifications for the sews8e disposal system on the above captioned property.
Type of system: El Conventional L7 Other % 14-- QwA. Septic Tank: / DDD gallons Pump Tank:
Subsurface No. of exact lengtl width of depth of
Drainage Field ditches of each ditch 2 5 b feet ditches feet ditches
French Drain Reauired: Linear feet
S�
Authorized State A�ent— o^ I_— - 141,'4"x- Date 3-7 3—
/
PWR Line
gallons
2 Z inches
f
15-5-37379 (1)
15-5-37379 (2)
ya
r
15-5-37379 (6)
15-5-37379 (7) -
C �
AP
15-5-37379 (3) 15-5-37379 (4) 15-5-37379 (5)
, ke
15-5-37379 (8) 15-5-37379 (9)
15-5-37379 (10)
15-5-37379 (11)
15-5-37379 (16)
15-5-37379 (12)
15-5-37379 (13) 15-5-37379 (14)
15-5-37379 (15)