OPHTE# I (,- < - X&3
PERMIT # 2 06 Z
Name: (owner) 11LpJ
System Installer.
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type: 25'1e
(In accordance with Table V a)
Harnett County Department of Public Health 24367
/OlDeration Pe it
New Installation Septic Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION4m1i95'3
�.n SUBDIVISION LOT #
i , Registration #
14 NumbeP
s
52 Publicl Distance from well _160 I + feet
4, Types V and VI Systems expire in S years.
ly
Owner must contact Health Department 6 months prior to expiration for /mit renewal.
This system has been installed in compliance with applicable North Camlib General Statures, Rules for Sewage Treatment and
3 1'5 -
5t >
U
V
I. Performance: System shall perform in acc:r.
with ule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached she far additional operation conditions, maintena a and reporting.
IV. Operation:
V. Other:
and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on the a(bp/ye captioned property.
Type of system: El Conventional Other 75�d �7p, Septic Tank: +j)n!� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of O
Drainage Field ditches of each ditch o a feet ditches 3 feet ditches 18 inches
French Drain Required: Linear feet
Authorized State AAeRt ,FF.--er C //lh.�,�„r Date t<