OPHTE# 1l�, - S . 3114'7 Harnett County Department of Public Health
PERMIT # Zak �Z '
eration Perm . � 24399
New Installation Septic Tank I�ffttrification Line ❑ Repair ❑ Expansion
PROPERTY LO[ATION:_'O�X54 (-c-&jr (L-% C ScL t-tz )
Name: (owner) VeAk V), kk o c SUBDIVISION LOT # 4 -
System Installer: Poex Registration #
Basement with plumbing ❑ Garage I� -- of Bedrooms
Type of Water Supply: ❑ Community la u-bM1ic� ❑ Well Distance from well feet
System Type: Z5;z /lt1 xc o� ]J r�, 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.
Inn 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: Q. a 2 5ct
I.
II.
III.
IV.
Performance: System shall perform in accordance with Rule .1961
Monitoring As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 9�'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Operation:
V. Other.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage '
osal system on the above captioned property.
Type of system:
❑ Conventional Other
-f A) /Lc�ot.,Etov� .Gz Ao.J Septic Tank:
t c70 O gallons Pump Tank: gallons
Subsurface
No. of
4—
exact length width of
depth of
Drainage Field
ditches
of each ditch feet ditches
3 feet ditches 1%inches
trench Urain Required: Linear feet
Authorized State Date O5
V
x _..
E
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