OPHTE# iG—S— 3,&s8 Harnett County Department of Public Health 24473
PERMIT # Z /0 eration Per It /
5 -/New Installation Septic Tank LO Nitrification Line ❑ Repair ❑ Expansion
�,� PROPERTY LOCATION5ti.2_ZI�NA+tu�Tr��4�_O ,eA
Name: (owner) !—'(� w� AAfi�=, SUBDIVISION alA:r� f /moi LOT # 3 2—
System
System Installer: Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms It
Type of Water Supply: ElCommunity Vublic ❑ Well Distance from well feet
System Type: ice' Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must con Health Department 6 months prior to expiration for permit renewal.
Il. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewae�disposaI s st"� on th above captioned property.
Type of system: ❑ Conventional Other s1My/N__5 Septic Tank: 2 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch _75- feet ditches 3 feet ditches llo 7 )E inches
French Drain Required:
Linear feet
Authorized State nt
L
,.,,y
/"L�i+
Date Z, t3— 1-1
16-5-39658 (1) 16-5-39658 (2)
16-5-39658 (6) 16-5-39658 (7)
.:441,
16-5-39658(11) 16-5-39658 (12)
16-5-39658 (3)
16-5-39658(8)
16-5-39658(13)
C4'
16-5-39658(4) 16-5-39658(5)
16-5-39658(g) 16-5-39658(10)
16-5-39658(14)