OPHTE# 11- 5 -'41057 Harnett County Department of Public Health 2 4 4 0
PERMIT # 2'15� Weration Permit 2
13�,Iew Installation LT�Septic Tank ErNfit�ification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: //pro i ae (,� rs sem•+ /U s2 rrSS)
Name: (owner) Lova 4l4_;a, SUBDIVISION LOT #
System Installer. I -,-- {\- rn Registration #
Basement with plumbing: ❑ Garage ❑ Number of�Bedr000
Type of Water Supply: ❑ Community El Public L.LYWell Distance from well "'50+
7-5A. A�A O'N — feet CP:t.cr'oS�:..D�
System Type:Types V and VI Systems expire in S years.
(In accordance with Table V a) 16wner must contact Health Department 6 months prior to expiration for permit renewal.
HIS system hu been installed in mmplianre with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and conswaion Authorisation.
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PERMIT CONDITIONS:
I. Performance:
11. 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 D----
If
/If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Fallowing are the specifications for the sewage dd system on the above captio�ned�ropetry
.
Type of system: ❑ Convent tL+�O her Fla a _Ly Septic Tank 1600 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 56 feet ditches _3 feet ditches Z6 inches
French Drain Required: Linear feet
Authorized State
Date cn-S / I G j I-q—
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