OPNTE# SO Harnett County Department of Public Health 24220
PERMIT # Z8f3o /Operation Pe It
5( New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOfATIO •x/937
Name: (owner) �' i�tri� :;;U, --SUBDIVISION LOT #
T
System Installer: ��. 3 Registration #
Basement with plumbing: ❑ Garage lumber of Bedrooms
Type of Water Supply''❑ Commu ity Public ❑ Well Distance from well feet
System Type: C3 �4 T 2 tZ (o' �—�+iyres Y and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 a disposal system on the above captioned property.
Type of system: ❑ Conventonal 70ther Z voolg;� Septic Tank: ) 001? gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches I of each ditch 3 0 feet ditches feet ditches �' Oa inches
French Drain Reauired: Linear feet
�.Q a c%r v (�
Authorized State A Pnt Date
15-5-37480 (1)
15-5-37480 (2)
15-5-37480 (3)
15-5-37480 (4)
15-5-37480 (5)
15-5-37480 (6)
15-5-37480 (7)
15-5-37480 (8)
15-5-37480 (11) 15-5-37480 (12) 15-5-37480 (13)
15-5-37480 (9)
15-5-37480 (10)