OPNTE# 11-5-419&P Harnett County Department of Public Health 24933
PERMIT # i940 Owation Perm'
lew Installation ERIeptic Tank ET Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: iq brctsa[vie C E �al, 6uieaC--ski 52t>fc�i 1
Name: (owner) r, ce,> L Y" 161 -s Lic - SUBDIVISION " fW C ewxLC - LOT # o
System Installer: EIviS l Registration # TT
Basement with plumbing: ❑ Garageuof Bedrooms
Type of Water Supply: ❑ Community PLd� ublic ❑ Well Distance from well NA feet
System Type: 5 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner st 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.
111. 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 -Box ❑
Pump ❑ Alarm
❑ H201-ine
❑ PWR Line
Following are the
specifications for the sewage dis tem a the above captionedd
Type of system:
❑ Conventional they
�,�J`'1
�i{�t:.M:e �lt_h
Septic Tank IUcn gallons
Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length
of each ditch feet
width of
ditches feet
depth of
ditches inches
French Drain Required: Linear feet
Authorized State Agent Date 03 123,a0
Mai J,