OP RHTE# t'~}~- Z Harnett County Department of Public Health
PERMIT # &go (0 peration Per 't 21 7 4 0
53 New Installation SeDtic Tank Zwltacation Line ❑ Repair ❑ Exuansion
PROPERTY LOCATION: O .
Name: (owner) 11 /A;2!2~=j iiZqC. SUBDIVISION LOT #
System Installer: < 7_41;i, ~ J3✓I Registration #
Basement with plumbing: ❑ Garaged umber of Bedrooms 3 ~
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: 6 f & gZ411 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must c ntact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North larohda beneral )tatutes, Nules tar )ewage treatment and Disposal, and all conditions of the
PERMIT CONDITIONS:
,P/L.
15,
I-
I. Performance: System shall perform in accordance with Rule .1961.
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:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the seewwaa disposal system on the above captioned property.
Type of system: ❑ Conventional L>!f Other~7? &0Lb,5`f J tasz E177 r :2L'41 Tank: 06 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches- of each ditch / feet ditches 43 feet ditches inches
French Drain Required: Linear feet
2/* A f go
Authorized State ent ,4-- Date l(
5F-4~/ I ~ ~ 1,
rermlt and Lon5tructlon Allmorizahon.
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