OPNTE# n!—i C9�y Harnett County Department of Public Health 24503
PERMIT # ;31, 3SZ /Operation Pe It
Lf New Installation Septic Tank O/Nitriffcation Line ❑ Repair ❑ Expansioe
PROPERTY LOCATIOftIgg2 )aroma is /2!&
Name: (owner)l%g,'f✓5 LS�/%�� SUBDIVISION A✓'7•C�r�S CJG/C,�ro LOT # SS
System Installer:// Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms
Type of Water Supp l : ElCommunity VPublic ❑ -W�ell Distance from well feet
% -s-A%7—System Type: __% -s-A%7— to 4Zypes V and VI Systems expire in S years.
(In accordance with Table V a) I' Owner mus— st contaCtaHealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance wish andiable North Carolina General Statutex Rules for Sewage Treatment and Dimosal. and
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Ys "
21
System shall perform in accordance with Mle .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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew disposal system on' then above japtioned property.
El of system: Conventional Other /c-
7 '� S: -1�„ L_41jeptic Tank: /'SD gallons Pump Tank: gallons
Subsurface No. of exact length 0 width of ZZ depth of
Drainage Field ditches_ of each ditch D feet ditches J feet ditches inches
French Drain Required: li/n�ear feet
Authorized State Agent—b C � Date g-7, -�
a q 0,
17-5-40974 (1) 17-5-40974 (2) 17-5.40974 (3) 17-540974 (4) 17-5-40974 (5)
17-5-40974(6) 17-540974(7) 17-540974 (8) 17-5-40974(9) 17-5-40974(10)
17-5-40974(11) 17-5-40974(12) 17-5-40974(13) 17-5-40974(14) 17-5-40974(15)
17-5-40974(16) 17-5-40974 (17) 17-540974 (18) 17-5-40974(19) 17-5-40974(20)
ommm
17-5-40974(21) 17-5-40974(22) 17-540974(23) 17-5-40974(24)