OPHTE# ll S-4oSZ9 Harnett County Department of Public Health 24493
PERMIT # 2-S3 s-7 ,//Operation Pe It /
New Installation Septic Tank 15 ' Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION6 /WS/26
Name: (owner) ,�o, v� Aag,, !616&e; Gcer+in SUBDIVISION d7zeri0 s c/c LOT # Vo
System Installer. 't -,a Oh a�l�.J Registration #
Basement with plumbing: ❑ Garage%dumber of Bedrooms
Type of Water Supply: El Community fel' PublicWell Distance from well feet
System Type: s -7 °40-4 o �TayPes-V and VI Systems expire in 5 years.
(In accordance with Table V a) caner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with
1. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operauon:
V. Other.
Statutm Rules for Sewaee Treatment and aimosaL and all
'We
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 -Box ❑ Pump ❑ Alarm ❑
Permit and construction Authorization.
H2OLine ❑
Following are the specifications for the sewage disposal on the�bove captioned property. 5442,
Authorized State A C_ Date %-2 q —
PWR Line
Type of system: ❑ Conventional
Others Septic Tank r gallons
Pump Tan k
gallons
Subsurface No. of
Drainage
exact length / width of
depth of
a, �✓,r.Y,f
Field ditches
of each ditch 400 feet ditches feet
ditches
(� hnche
French Drain Required:
Linear feet
C.® ° �
,
:�
Au