OP RHTE# 69 -5- - ZLAOilq Harnett County Department of Public Health
PERMIT # 2 '41A0 i Operation Perm —it ' 2 2 4 5 7
/
Ear New Installation LJ Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:ePLe ,/e,3 46
Name: (owner) 'Ad' ,�� SUBDIVISION (ir�l cif LOT # 9
System Installer: 7/7+g� Z2i � Registration #
Basement with plumbing: ❑ Garage 9 Number of Bedrooms cf
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ' Ga JF7, 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.
PERMIT CONDITIONS:
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z 7� Septic Tank: /Z¢ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch n feet ditches feet ditches _5 �& inches
French Drain Required: Linear feet
Authorized State Agf!E��
� Date _ Z� �1 Z,,.
08- 5- 20019R (1)
08- 5- 20019R (2)
08- 5- 20019R (3)
08- 5- 20019R (4)
08- 5- 20019R (5)
08- 5- 20019R (6)
08- 5- 20019R (7)
08- 5- 20019R (8)
08- 5- 20019R (9)
08- 5- 20019R (10)