OPHTE# I 5-- '-3&LI`3 Harnett County Department of Public Health 23789
PERMIT # Z��� Operation Per it
2"'New Installation Septic Tank 12 Nitrification Line ❑ Repair ❑ Expansion
® PROPERTY LOCATION:1 �a /<�r /ltt_/f /-'�
Name: (owner) L" j � ,,,�C,9 SUBDIVISION LOT #
System Installer: c lt '' ftRegistration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Z" Public ❑ Well Distance from well feet
System Type: 4*,— b Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contaV Health Department 6 months prior to expiration for permit renewal.
rcnrui ivivuiiiuir3:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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.
Operation:
Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12OLine ❑ PWR Line
Following are the specifications for the sdisposal system on the above captioned property.
Type of system: Elews Conventional Other Septic Tank: )ZOD gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch O a feet ditches 3 feet ditches 20 inches
French Drain Required: Linear feet
15-5-36413 (16) 15-5-36413 (17) 15-5-36413 (18)
dt
P.
15-5-36413 (1)
15-5-36413 (2)
15-5-36413 (3)
15-5-36413 (4)
15-5-36413 (5)
15-5-36413 (16) 15-5-36413 (17) 15-5-36413 (18)