OP RHTE# /h -5 - 0' Y761le Harnett Lounty Department of Public Hewth 21 0 6 3
PERMIT # 26o0to Z Operation Flow
New Installation Septic Tank ❑ Repair LZ Nitrification Line ❑ Expansion
PROPERTY LOCATION:-V
Name: (owner) -7_o ,0 D SUBDIVISION / G,a-~ IFS LOT # q
System Installer: Registration
Basement with plumbing: ❑ Garage ___/~umber of Bedrooms 3
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: 2'5%9,66,(fz r1 z~} ST,~✓A- _/1yg120 t?P G r~u411 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) JJ Owner must contact Health Department 6 months prior to expiration for permit renewal.
Operation:
Other:
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional Other ZS°!o i o)tl LF
1(/>S Septic Tank: 100 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch / 17 C) feet ditches 3 feet ditches 2 ~ inches
French Drain Required: Linear feet
Authorized State Agent ` c - Date / Z--'1 q `/0
rrnimi w14v111un3:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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.
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