OPHTE# 1 Harnett County Department of Public Health 24263
PERMIT # 2 2'1 /0 eration Pe It
Ei/ New Installation Septic TankNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONZX-/oAe. a/v .s7n-�,c /zO
Name: (owner) - .42 r,4 C— SUBDIVISION 6y. x-6 WcxxoS LOT # .3A.
System Installer: Registration #
Basement with plumbing: ❑ Garage Slumber of Bedrooms 3
Type of Water Supply: El Community fes' Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 0 er must�tblttact Healt Department 6 months prior to expiration for permit renewal.
QvtcC. a1
This system has been installed in wmpliance with applicable h Carolina General Shtutes, Rules for sews ent and Disposal, and all wnditions of the Improvement Permit and Conswcdon Authorisation.
I
16'
I. Performance:
If. Monitoring
III. Maintenance:
IV. Operation:
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.
❑ D -Box ❑ Pump ❑
0
H2OLine ❑
PWR Line
Following are the specifications for the se—wsje disposal system on the above captioned property.
Type of system: ❑ Conventional fG Other s /(oto Septic Tank: 10150 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches L of each ditch /70 feet ditches 3 feet ditches 7inches
French Drain Required: Linear feet
Authorized State A�eat� w�—+�> Z r�/�u � �'v Date /I - S ` /L
i f
3
16-5-39317 (1) 16-5-39317 (2) 16-5-39317 (3) 16-5-39317 (4) 16-5-39317 (5)
I •ti
16-5-39317 (6) 16-5-39317 (7) 16-5-39317 (8) 16-5-39317 (9) 16-5-39317 (10)
ear is _�: _ `,��,�a.