OP(Er )
HTE# 11� Harnett County Department of Public Health 941 81;
PERMIT # Z 88 ?3 Operation Pernfit
❑ New Installation 19 Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION.24 SS -°d Z-��Z .c -W !LS
Name: (owner)11" `� A*v SUBDIVISION LOT #
System Installer: Ton Registration #
Basement with plumbing: ❑ Ga age [if Number of Bedrooms _3
Type of Water Supply: ❑ Community 12' Public ❑ Well Distance from well feet
System Type: 1:7 Types V and 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.
This system has been installed in compliance with applicable North Cfrolina General Statutes, Rules for Sewage Treatment and Disposal, and all continent of the Improvement Permit and Construction
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
'V Y
aW
q��Dp irk 1A
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 ❑ M201-ine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other Ail L.) % A -p.) iz Septic Tank: /000 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches -- feet ditches
French Drain Required: Linear feet
l
Authorized State Av6t �i�---�—� / _ t /i � Date
PWR Line
—"" gallons
inches
rds Repair Tank Replacement rds Repair Tank Replacement rds Repair Tank Replacement rds Repair Tank Replacement