OPHTE# u`1- s=~-XaZG Harnett County Department of Public Health 2 0 7 0 8
PERMIT # DiDeration Permit
ET-New Installation Il" SePtic Tank El Repair ~frification line 0 Expansion
/J PROPERTY LOCATION: o2Z ~er~ Name: (owner) A - r f l ~.r o A SUBDIVISION CO LOT #
System Installer. L' l J c,, , c f 4- Registration #
Basement with plumbing: ❑ Garage ❑ -twmber of Bedrooms 3
Type of Water Supply: ❑ Community fT Public ❑ Well Distance from well feet
System Type: G" 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.
11111 Spiem Has peen MOM to
DGRMIT rnAlnlTIAW
North laronna t,eneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
CP
C
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.
Following are the specifications for the sewage ' posal system on the above captioned property.
Type of system: ❑ Conventional Other IC1oc,--1 Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
French Drain Required: linear feet
L
Authorized State Agent ~2- _ Date q <S' ~a Q ~
~~-s"--ZZaZV
fit
17, -1,
Alk
t tx*~f
F
44
~ > +tr
Ono
r
Pit=
a , r tZ«~~
BUT
I'T
S 3 A ~
7 too
Enna
h ~ ~ f 3 ! ~ fir`. ~ ~y r y K
0004,
F
r A
3 y ~ "f
.e
~ a
'3.. a v t
k i Y.s
I. y
r- r ? ;
r 4 .i ~ X
All
i yam..,..
1 7_.:+I
2