OPHTE# jq= q3eZf Harnett County Department of Public Health 24812
PERMIT # 21!;e&D � ration Perm' ��
New Installation Septic Tank Itnfication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION eZ!K
Name: (owner SUBDIVISION v LOT # -ZD
System Installer. Registration #
Basement with plumbing: Garage � /NyJN,�1,Iber of Bedrooms
Type of Water Supply: nCommunity L rUDIIC Well Distance from well feet
System Type: ;�d��'���iJ/& Types V and VI Systems expire in S years.
(In accords a w' Table V a) Owner rr�y,�ealth Department 6 months prior to expiration for permit renewal.
with applicable Borth Carolina General statutes, Rues^• e.,.. -a r./,._.... and n:.._.., .... A ,wuoj,ne of the Improvement Permit and (onstruttion
A t1_3
Lie /
/\ / V F
I. Performance: System shall perform in accordance with Rule .1961. 0
II. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews dispQ3�I system yn the above captioned grope
Type of system: ❑ Conrentional Other V r d-5 � Septic Tank: �� gallons Pump Tank:._ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch � feet ditches Z.> feet ditches �_ inches
French Drain Required: Linear feet
Authorized State Agent Date - >G1;?ybR ,6
18-543076 (1)
18-5.43076 (2)
18-643076 (3)
18-5-43076 (4)
18-5-43076 (5)
18-5-43076 (6)
18-5-43075 (7)
18-5-43076 (11) 18-5-43076 (12)
18-5-43076 (8)
18-5-43076 (9)
18-5-43076 (10)