HomeMy WebLinkAboutOPHTE#_ISG'-S-y� 7 Harnett County Department of Public Health 2 4 9 5 7
PERMIT # �/Uo 0 ation Permit s2
Iew Installation �Nitriricati
Septic Tank on Line ❑ Repair E]Expansion,y q3
PROPERTY LOCATION: rq 0�ic Ln
Name: (owner)=tr.�ndPUc�n . Pm<.., i� i� SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garagem1-�f Bedrooms
Type of Water Supply: Elcommunity C�blic ❑ Well Distance from well NA feet
System Type: 216
!'�>6 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner m tact Health Department 6 months prior to expiration for permit renewal.
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑
H2OLine ❑
Following are the specifications for the sewag�e 9�sal system on, �thet above ca do
Type of system: El Conventional 0 �pvJ Septic Tank: gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches V�
French Drain Required: Linear feet
Authorized State Agent Date 01 (a3 Ja08
PWR Line
gallons
inches
10