OPHTE# Y5-537QL0, Harnett County Department of Public Health 24271
PERMIT # a,��$5 0 eration Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: SP, G -e.
Name: (owner) H x -P QcA5I17E llas-�5 SUBDIVISION Wfl.l�4tl , Gno+L LOT #
System Installer. 'nma 5 OSrscL-. . Q.Aa9 Registration #
Basement with plumbing: ❑ Garage '�K Number of Bedrooms L
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1Stii Types V 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and lonsbuttmn Authoneahon
V
APIA iD
L_rr; ( -
PERMIT CONDITIONS
I. 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 ❑ Norx
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. 5r..v- k').R SuPoL:j ",3c— c— 4Ra' Q"40 A 6fF L-OCK-S' OtJ
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposaj fystem on the -above captionedproperty.
Type of system: ❑Conventional X Other j vmp L �Z Ftpiz Septic Tank: 16Od gallons Pump Tank 16 0 0 gallons
Subs No. of exact length width of depth of
Drainage Field s V of each ditch 3 feet ditches 3 feet ditches S�"'c inches
French Drain Realsiced; Linear feet
Authorized State AeentDate
I �-5-3?643.