OPHTE# d1-6-=aHarnett County Department of Public Health
PERMIT # ak- t 0 eration Permiitt 2201 7
New Installation It[J Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
/ PROPERTY LOCATION: ~5-~ 3 C-Q~~~t~
Name: (owner) C, tCr SUBDIVISION LOT #
System Installer: /h a i'.s_ y Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .-7
Type of Water Supply: ❑ Community ❑ Public Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
finis system nas ueen mstaueo in
with applicable north larohna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
PA a
t~
M
a
Permit and Construction Authorization.
i uun1 wnvinvn.i.
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
Following are the 'fcations for the sewage disposal system on the above captioned property.
Type of system: speConventional ❑ Other
Subsurface No. of ! exact length
Drainage Field ditches of each ditch feet
Septic Tank: /00 c) gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
French Drain Required: Linear feet
e
Authorized State Age 1~j~lf Date
Alarm ❑ H201-ine ❑ PWR Line
F
i
9
`
n.
~
{
y
~ ,
t'- ~
i
~
a
.,,r.~
~
~
„
a,~'.
~i -
f`
e
q~.
~:t
E ~
g;
i~
~a~
~
o-
~
~
~
}
"
T
~ `
~ 1
~
w
fig
~
k
t
,zr
t~
~
i
s
.
~
,
~
r
s ~
4
,i~ },kr
l
~
~
~
.
y
y
r
~
~
J.
-S ry
a
~y. .
f!
`
~
~
L
r
4i H
T k
'
#
~ ,
f
- Y
-
1
~