OPHTE# «- -� - 4or cs Harnett County Department of Public Health 24400
PERMIT # 7-1-115 0 ration Perm �
New Installation Septic Tank Ni/trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 4y9 Crass c ✓_ by IiCwU Sp rays r� s2 ��
Name: (owner) C-"I�.rJ. Ac,Na,a9-, Lei C • SUBDIVISION Cross l K P(y, LOT # q%F
System Installer: & \ w \r,;)\ Registration #
Basement with plumbing: ❑ Garage DeR of Bedrooms —3
Type of Water Supply: ❑ Community Eir Public ❑ Well Distance from well feet
System Type: Z 'w nG�,r ter, �> 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 construction Authorization
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑
❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for the sewage di sal system on the above captioned property.
Type of system: 111 Conventional 51- they ZS% Uww.\..Septic Tank: "0w gallons Pump Tank: gallons
Subsurface No. of exact lengthwidth of depth of
Drainage Field ditches 4- of each ditch L=S feet ditches 3 feet ditches Z4 inches
French Drain Required: Linear feet
Authorized State Agent Date s / 17- / r
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