OPNTE# 4q Harnett County Department of Public Health 2 4 3 8 9
PERMIT # ZS3 eration Per i �
New Installation Septic Tank Itrlftcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t Ser 2ocd C 52
Name: (owner) M055 IloM.P✓`ovAfo SUBDIVISION LOT #
System Installer. 41¢.,C r4osS, Registration #
Basement with plumbing: ❑ Garage � Nu�fof Bedrooms
Type of Water Supply: ❑ Community LR�Public ❑ Well Distance from well feet
System Type: Z57rtcl d b. .n =C— 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.
cols system nos oven installed In compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Dispmal, and all conditions of the Improvement Permit and Construction Authorization.
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1TA. 52 $4—yR1,
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage�P°saI system on the above cap!ioned property. .
Type of system: El Conventional O'Other 47c-7 2& r, Septic Tank: /yv6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch /00 feet ditches Z feet ditches 17D-" inches
french Brain Required: Linear feet
Authorized State Agent Date 01 z s 1
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