OPHTE# Id 5-y3333 Harnett County Department of Public Health 25001
PERMIT # e0g6g4 0 eration Permi
lew Installation Septic Tank 9%trlflcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: '13 Chln mrKb/l a ( 01A A a - al t- Sic fe.4oC)
Name: (owner) Cx-j, 44C,,AL>� T., c f�xF��
SUBDIVISION Cz1 W c�c �t LOT #
C-.r,r- 26' JJ
System Installer: \ e 1' Registration #
Basement with plumbing: ❑ Garage um . of Bedrooms 3
Type of Water Supply:❑Community ublic ❑ Well Distance from well �^e� feet
System Type: �= S s -G Types V and VI Systems expire in S years.
(In accordance with Table V a) i5rOwner m contact Health Department 6 months prior to expiration for permit renewal.
this system has been imtalled In compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtRMll IUNUIIIUNS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the sewa `sposal system on the above ca tioned property.
Type of system: ❑ Conventional Other 04 i h"65- Septic Tank: IC?C gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch —4'6 feet ditches 3 feet ditches
French Drain Required: ' Linear
Date d IIq Role,Authorized State Agent:6
PWR Line
gallons
inches
p
G)
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0
-
rop
0