OPHTE# /G -S —.W6.9 Harnett County Department of Public Health 24363
PERMIT # 2 Iqq1 —/ Operation Per It
New Installation M Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION:�5- ,% Qe� ,g IZZ�
Name: (owner) ut .//s iiti,J SUBDIVISION LOT # I
System Installer:Registration #
Basement with plumbing: ❑ Garage If umber of Bedrooms Z
Type of Water Supply: ❑ Community Lh Public ❑ Well Distance from well feet
System Type: %b .&i6 Types V and VI Systems expire in S years.
(In accordance with Table V a) I Owner must Atact Health Department 6 months prior to expiration for permit renewal.
rtxnu tununwns:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑
H2OLine ❑
PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: El Conventional [� Other LS%R Ayd6 2- oQ+.� Septic Tank: /UUa gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch_ feet ditches _ feet ditches inches
french Drain Required: Linear feet
Authorized State Agee /" It4nih�) Date `f —
L/
16-5-39303 (1)
16-5-39303 (2)
16-5-39303 (3)
16-5-39303 (4)
16-5-39303 (6)
16-5-39303 (11)
16-5-39303 (7)
16-5-39303 (8)
16-5-39303 (9)
16-5-39303 (5)
16.5-39303 (10)