OPHTE# )(9-5-1e13a Harnett County Department of Public Health 24398
PERMIT # Z9Z 3 OiDeration Permit_
New Installation Septic Tank cation line ❑ Repair ❑ Expansion
PROPERTY LOCATION: (2o,3Iwa e r: e_ �ct,4N�1,¢ tG r\,d . s(Z, a4a=)
Name: (owner) 0jnn C6n.3�rJL is on. 1 SUBDIVISION Avera Oona LOT # 12
System Installer: Registration #
Basement with plumbing: ❑ Garageu�r of Bedrooms 4 -
Type of Water Supply: ❑ Community 2' Public ❑ Well Distance from well feet
System Type: LS%, /t�uc :ott 'wily 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.
Ibis system has been installed in compliance wiN applicable North Carolina General Statutes Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS: fLo w A N n p n s
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 ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage�ral system on the above captioned property.
Type of system: ❑ ConventionalCT Other z59c, gg ' Di F.; ,, r O Septic Tank: /6� o gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch y `><U feet ditches 3 feet ditches 7,C inches
French Drain Required: Linear feet
Authorized State Agent — Date CX1'/ 66 hC7—
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