OPHTE# I� —5 - fobs q Harnett County Department of Public Health 24864
PERMIT # Dwration Per bt- '
New 'Installation Septic Tank F Nitrification Line ❑ Repair ❑ Expansion s-41
PROPERTY LOCATION: C,4 PuMp 6&L .,) 21 ( c)ld SEsx � 1
Name: (owner) �,�\ Pow _ SUBDIVISION T24 Gs pt E LOT #
System Installer. bra c,tL— Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _IF
Type of Water Supply: ❑ Community 19-1riblic ❑ Well Distance from well 50'1 feet
System Type: Q 5Y 7i Types V and VI Systems expire in S years.
(In accordance with Table V a) a Owner must contact Health Department 6 months prior to expiration for permit renewal.
I. Performance: System shall perform in accordance with Rule .1961.
IL 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:
Other.
❑ D -Box
❑ Pump ❑
Alarm ❑
H20Line ❑ PWR Line
Following are the specifications for
the se�wage�d' Posal system on the above captioned�proP�rry.
274
Type of system: ❑ Conventional
LVOther 36 Lhcun�i[r
Septic Tank I CZXI�
gallons Pump Tank er gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches
�J of each ditch i� feet
ditches 3
feet ditches IeO 4, .o inches
French Drain Reouired:
linear feet
Authorized State Agent 440/ , Date All15 1 ort,fq