OPHTE# ►G -S-'-'" 1" Harnett County Department of Public Health 24632
PERMIT # 1A 1-/0 station Permi -
El New Installation Septic Tank 2"kitriffcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rL iyA
Name: (owner) 5556 SUBDIVISION LOT # _r
System Installer: nes 5 l Registration #
Basement with plumbing: ❑ Garage E ber of Bedrooms _3
Type of Water Supply: ❑ Community LtY Public ❑ Well Distance from well feet
System Type: 7_S 9,�2 F4Aor.Li v n S., c - IIro Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (onsnuction Authorization
YtNMII LUNUIIIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 -Boz ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches 3 of each ditch feet
French Drain Recruited: Linear feet
X
H2OLine ❑
Septic Tank: t Ci c'CG gallons Pump Tank
width of depth of
ditches feet ditches ZC>
Authorized State Aeent/ / Date 6-7 / o q / I
PWR Line
gallons
inches
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146' 140'
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YtNMII LUNUIIIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 -Boz ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches 3 of each ditch feet
French Drain Recruited: Linear feet
X
H2OLine ❑
Septic Tank: t Ci c'CG gallons Pump Tank
width of depth of
ditches feet ditches ZC>
Authorized State Aeent/ / Date 6-7 / o q / I
PWR Line
gallons
inches
Irl
_Ole-