OPHTE# 1(4 -S-40361 Harnett County Department of Public Health
24395
PERMIT # 7-5 Z9 y 0 eration Permi �
lew Installation Septic Tank i� itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Tol7n5lr/2 G,. Z. _ l!<t. �52 lsslJ
Name: (owner) C"J" a:Ic- SUBDIVISION LOT # _44
System Installer: Qx cry nd 5 c. Registration #
Basement with plumbing: ❑ Garage� �u of Bedrooms .3
Type of Water Supply: ❑Community PIJ' ublic ❑ Well Distance f om well feet
System Type: Z5%o /Ce d c 6<oa w , s. Z 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 Concoction Authorisation
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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 sewage d�is ��kystem on the above captioned property.
Type of system: ❑ Conventional nther _Z-5 %o 459 -- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 30`0 feet ditches 3 feet ditches _%fl inches
French Drain Required: Linear feet
Authorized State Agent -Z;� Date OSU 3'Il
VA