OP3714r
HTE# 912? Harnett County Department of Public Health 23961
PERMIT # ole (,40 0 eratlon Permit
17/New Installati
c Tank 7/
Nitrification Line ❑ Repair ❑ Expansion
RR PROPERTY LOCATION:
Name: (owner) lC SUBDIVISION LOT # 4
System Installer: J O+a-: r- S� - x` it l d Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 52"'Public ❑ Well Distance from well feet
System Type: Types V and A Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
cols wsrem nos peen mfalRa In compliance Wim appllaule nuns arwula eeneRi uamses, Rules for
I A'-sj �
i��r p ; , n
/'AE^
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No El
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Bax
❑ Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the
specifications for
the sew disposal systes� qn the above captioned property.
Type of system:
ElConventional
( Other G Z f/o J Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
y of each ditch sU feet ditches 3
feet ditches inches
French Drain Required: Linear feet
Authorized State Age c Date 3
j(, - -2F (
-5 -,7 ? L