OPHTE# /L-�s-931 Harnett County Department of Public Health 24266
Q�3
PERMIT # � /Operation Per
New Installation Septic Tank ra' Nitrdication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:��y io �•� O"
Name: (owner) e C SUBDIVISION 4',--, L. JOT # t
System Installer:Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Sup pl : ❑ community Public ❑ Well Distance from well feet
System Type: ,dAy— T ' Types V and VI Systems expire in S years.
(1n accordance with Table V a) Awner must &Wct Health Department 6 months prior to expiration for permit renewal.
I. Performance: System shall perform in accordance with Rule .1961.
It. 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 seewwsf disposal system on the above captioned property.
Type of system: El Conventional I? Other —264970 Aila Septic Tani. OW -9 b gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 10 5 feet ditches 'Z> feet ditches 1 2 inches
French Drain Required: Linear feet
Authorized State A t <f� Date
7 ,,rrgJul 1�
V
3
, � i: - .. [I j -�
16-5-38831(11) 16-5-38831 (12) 16-5-38831 (13) 16-5-38831 (14) 16-5-38831(15)
'}:wl \. i. _•.. `y !'��-•...� SYS � .,
16-5-38831(16) 16-5-38831 (17) 16-5-38831 (18) 16-5-38831 (19)