OP RHTE# /L—S 3$ZS7/Z Harnett County Department of Public Health 24047
PERMIT # 189/5"' 0 eration Pe It /
New Installation Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION:S2S /s -;ii s /MOO"
Name: (owner) —A-..,o(ael /✓/t.✓S SUBDIVISION LOT # Z
System Installer. —36hb. sn� Registration #
Basement with plumbing: ❑ Garage ❑ /Flumber ofBedrooms
Type of Water Supply: El Community Eir Public Q Well Distance from well feet
System Type: ill V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact H Ith Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2O1-ine ❑
PWR Line
Following are the specifications for the sew a disposal system on the above cap'no d rope
Type of system: ❑ Conventional Other Ze% 16 riOLJ/ IY'^� Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length — width of depth of 4
Drainage Field ditches 3 of each ditch S0 feet ditches 3 feet ditches Z4 inches
French Drain Required: Linear feet
Authorized State Aot=T ,�, 2 1 Date S-14.16
16-5-38257R (6) 16-5-38257R (7) 16-5-38257R (8) 16-5-38257R (9) 16-5-38257R (10)
16-5-38257R (11) 16-5-38257R (12) 16-5-38257R (13) 16-5-38257R (14) 16-5-38257R (15)
16-5-38257R (16)
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16-5-38257R (1) 16-5-38257R (2)
16-5-38257R (3)
16-5-38257R (4)
16-5-38257R (5)
16-5-38257R (6) 16-5-38257R (7) 16-5-38257R (8) 16-5-38257R (9) 16-5-38257R (10)
16-5-38257R (11) 16-5-38257R (12) 16-5-38257R (13) 16-5-38257R (14) 16-5-38257R (15)
16-5-38257R (16)