OPHTE# I :: o95 Harnett County Department of Public Health 24970
PERMIT # -29915
eratlon Perm
EJ�New Installation Septic TankNim trification Line ❑ Repair
� Re airPROPERTY LOCATION:
xpansionName: (owner) WMJpe
SUBDIVISION 2 xr �1J (52 tq{ pl
System Installer.. 1 �LOT # Z J
Basement with plumbing. ❑
Garage Registration #
Type of Water Supply: ❑ community
g Q of Bedro3ln 3
System type: SG ry ublic ❑ Well Distance from well N
feet
(In accordance with Table V a) Types V and VI Systems expire in S year.
0 ust contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General statutes. Rules for Sewage Treatment and Disposal and all cendinons of the Improvement Permit and rnnnn—... A....-
PVM9 --c"
yt.�caasz Ara.Ep
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2
L
L Performance:
H. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
10
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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 CeT
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑
Pump ❑ _� Alarm ❑
Following are the specifications for the sewage sal system on the above captioned rorty. � M20Line ❑ -_ PWR Line
Type of system: ❑ Conventional Ot��,
Subsurface No. of Septic Tank:
exact length �_ gallons Pump Tank gallons
Drainage Field ditchesof each ditch �� width of depth of
-- Linear feet
French Drain Required: feet ditches �_ feet ditches 16
inches
Authorized State
Date 65 l l l l �b o
Z
m
--,mum. f,
21