OPHTE# Ifs -n5- �If3 Harnett County Department of Public Health 24986
PERMIT # a� d`� eratlon Per '
LT New Installation EKSeptic Tank alitrirfcation Line ❑ Repair ❑ Ezpa 'on
PROPERTY LOCATION: a5Q 'Sa tYo Dy8 qq/ 1J.
Name: (owner) Cc - ,c\ (w c e.5 SUBDIVISION S ,k\r\ LOT #
System Installer: L\ S o
Y Registration #
Basement with plumbing: ❑ Garage ❑/Number of Bedrooms N t..SClI—e�r�'� ..� 4 � 1
Type of Water Supply: ❑ Community V Public ❑ Well Distance from well tJ N feet O
System Type: f S 5 Types V and VI Systems expire in S years. N00r" rh �X
(In accordance with Table V a) ner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nonh Carolina General Statute; Rules for Sewage Treabnent and Disposal, and all conditions of she I rorement Permit and Consauci Auth
nW ion orii
rxnmi CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordanceith Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No fid
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sewatpAposal system on the above capti�oned�r9perty.
Type of system: ❑ Conventional 16 Other 04- C)^[ mlierI Septic Tank gallons Pump Tank:
Subsurface No. of ^^ exact length ' ' r� width of depth of
Drainage Field ditches d of each ditch `t"'V feet ditches feet ditches
french Drain Required: Linear feet
Authorized State Agent �� �� /-!/ Date C---) 4, aC) o'ZC
PWR Line
gallons
inches
aa ion.
'SlaCt.Cr� xYta�E
�t
t.JPhsN1�4E.,
P�✓.a tJ6
\�
A 1
1'8
ra
7a�o-
I51_
rxnmi CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordanceith Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No fid
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sewatpAposal system on the above capti�oned�r9perty.
Type of system: ❑ Conventional 16 Other 04- C)^[ mlierI Septic Tank gallons Pump Tank:
Subsurface No. of ^^ exact length ' ' r� width of depth of
Drainage Field ditches d of each ditch `t"'V feet ditches feet ditches
french Drain Required: Linear feet
Authorized State Agent �� �� /-!/ Date C---) 4, aC) o'ZC
PWR Line
gallons
inches