OP RRNTE# ( Harnett County Department of Public Health 24369
PERMIT # eratoP It
12
New 'Installation
d Septic Tank r]3' Nitrification Line ❑ Repair ❑ Expansioe
PROPERTY LOCATIO N J
Name: (owner)('f)�..rJn—) / rl a�34—nb_"-- SUBDIVISION LOT # _16
System Installer: _Pq-6 / �P I u Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑_ Comma sty ^ Public ❑2Well Distance from well feet
System Type: v ypes V and VI Systems expire in S years.
(In accordance with Table V a) wner m coact Health Department 6 months prior to expiration for permit renewal.
L4r
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
Other.
urollna uenenl Ea dR5, nines lol
I Rannenl and UISDOSM. and all ZOOOmOnS 01 me Iduf0w1IROt remut and t0rd nalon RYlnorlZation.
I �
I
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 -Bax ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for the sewa isposal
system on the above captioned property.
Type of system:
❑ Conventional Other
�� /L9TQ
Septic Tank: I gallons Pump Tank:y gallons
Subsurface
Drainage Field
No. of
exact length
ZZifr
width of depth of
3
ditches
of each ditch feet
ditches feet ditches inches
trench Dram Required: Linear feet
Authorized State Ag Date — « —1-7
16-5-39345RR (1)
16-5-39345RR (2)
16-5-39345RR (3)
16-5-39345RR (4)
16-5-39345RR (5)
16-5-39345RR (6)
16-5-39345RR (7)
16-5-39345RR (11) 16-5-39345RR (12)
16-5-39345RR (8)
16-5-39345RR (9)
16-5-39345RR (10)