OPHTE# 3821N- Harnett County Department of Public Health 24194
PERMIT # 2 BS -79 Operation I�llt
GY' New
Installation ❑' Septic Tank a� Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION:ciz2lNy� AZ
Name: (owner) e u�C�ta ez 61D2S- 4�c. SUBDIVISION -4-T' tea. LOT # -z-
System Installer. he -.y— ff Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community FeK Public ❑ Well Distance from well feet
System Type: G6 rTypes V and A Systems expire in S years.
(In accordance with Table V a) caner must contact Health Department 6 months prior to expiration for permit renewal.
This system her been Installed In
benenl
Holes lot 1evmee treatment arm msbosal, imo all tonmnons of me improvement rermit ana wnrmmamn
n sFn
PERMIT CONDITIONS:
1. Performance:
11. 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.
rug
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal syys�tem on the above coned proprt�
Type of system: ❑ Conventional ❑ Other 2�- Zn (ZoeS? c ` , Septic Tank: 10D J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch Fd o feet ditches 3 feet ditches L y inches
French Drain Required: Linear feet
q
/ r / QwrS
—7� 1
Authorized State Agents ��lA�/z�* vT Date !L^
16-5-38814 (1)
16-5-38814 (2)
16-5-38814 (7)
16-5-38814 (3)
6
16-5-38814 (4) 16-5-38814 (5)
I
{+
r
C
I Q
-
16-5-38814 (6)
16-5-38814 (2)
16-5-38814 (7)
16-5-38814 (3)
6
16-5-38814 (4) 16-5-38814 (5)