OPNTE# t�7 ' V77-76
PERMIT # 207 1-7L
Name: (owner) —4_4
System Installer. _Z
Basement with plumbing: ❑
Type of Water Su ply: ❑ Co
System Type: An
(In accordance with Table V a)
This system has been
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Harnett County Department of Public Health 24819
2 New Installation D,
PROPERTY LOCATION
SUBDIVISION
T— Registration #
Tank L; -I lfication Line ❑ Repair ❑ Expansion
f Bedrooms !�f
❑ Nell Distance from well feet
Types V and III Systems expire in 5 years.
Owner mu Health Department 6 months prior to expiration for permit renewal.
IJ
Lfe'5r-D
IS-jt�a
System shall perform in accordance with Rule .1961
As required by Rule .1961.
As required by Rule .1961. Other.
and all conditions of the Improvement Permit and
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t4,,yZ%
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
r.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for
the sewa disposal system on the above captioned property.
Type of system:
El Conventional
Other �e /�2412:F�!/L
Septic Tank: �, gallons
a
Pump Tank: / L'5�c) gallons
Subsurface
No. of
exact length
3
width of
depth of
Drainage Field
ditches
of each ditch feet �� feet
ditches feet
ditches 242 inches
French Drain Required: Linear feet
Authorized State A <5—� ��/ S Date
17-5-42776 (1) 17-542776 (2) 17-5-42776 (3) 17-5-42776 (4) 17-542776 (5)
Y�
i
17-5-42776 (6) 17-5-42776 (7) 17-5-42776 (8) 17-5-42776 (9) 17-5-42776 (10)-
17-5-42776(11) 17-5-42776(12) 17-5-42776(13) 17-5-42776(14) 17-5-42776(15)
17-5-42776(16) 17-5-42776 (17) 17-5-42776 (18) 17-5-42776(19) 17-5-42776 (20)
,17-5-42776 (21) 17-5-42776 (22) 17-5-42776 (23) 17-5-42776 (24) 17-5-42776 (25)
17-5-42776 (26) 17-5-42776 (27) 17-5-42776(28) 17-5-42776 (29) 17-542776 (30)
17-5-42776 (31)