OPHTE# (I - 5-Now31- Harnett County Department of Public Health 24639
PERMIT # Z- (1 S4 3 Owation Permi - �
New Installation Septic Tank El -ftnflcation line ❑ Repair ❑ Expansion
PROPERTY LOCATION: A+k,„s n A. ( Sit yvxlYi)
Name: (owner) u 6 &r SUBDIVISION A-Lttr„s yjAj a_ LOT #
System Installer ma's ptf,4I; a Registration #
Basement with plumbing. ❑ Garage � amber of Bedrooms
Type of Water Supply: ❑ Community I� Public ❑ Well istance from well feet
Z
System Type: S% t1.e��Ll oA 5�6iern Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been insulted in amoliana with aoolicable North (amlina General Statutes. Rule, for Sewa.e Tr,. mem and nlmmal ,nd all r.nditmn, nl Ih, nnor,,..n,.m e.md...d r.,,,M,.d,,,, a,nh.n... mn
YtNNII LUND111UNS:
I. Performance:
It. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage sposal system on the above captioned roperty.
Type of system: ❑ Conventional Other x r LOW �j Septic Tank I z.,So gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch (5 feet ditches 3 feet ditches �8 inches
French Drain Required: linear feet
Authorized State Agent Date t)4 /it ZE i
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YtNNII LUND111UNS:
I. Performance:
It. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage sposal system on the above captioned roperty.
Type of system: ❑ Conventional Other x r LOW �j Septic Tank I z.,So gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch (5 feet ditches 3 feet ditches �8 inches
French Drain Required: linear feet
Authorized State Agent Date t)4 /it ZE i
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