OPHTE# 11 - � - uocyy Harnett County Department of Public Health 24637
PERMIT # Z -f Owation Permi
New Installation eptic TankItriftcation Line ❑ Repair ❑ Expansion
PROPERTY LO[ATION:6,rlL. ( 6 aj C 52 to
Name: (owner) Cc.nn,e � C1u. m5 C„rr n SUBDIVISION LOT _L
System Installer: \ x M\ 055 Registration #
Basement with plumbing: ❑ Garage ❑ ber of Bedrooms
Type of Water Supply: ❑Community el Public ❑ Well Vigilante from well feet
System Type: ZS v ae'&v .5Types V and VI Systems expire in S years.
(In accordance with Table V a) Ovemust contact Health Department 6 months prior to expiration for permit renewal.
[his system has been installed in compliance with applicable North Carolina General Stations, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Peters and Construction Audiuriaatiun
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 disposal system on the above captioned�r perty.
Type of system: El Conventional l�ther �- L w o > Septic Tank: he—,4> o gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch feet ditches 3 feet ditches Z.6 inches
French Drain Required: Linear feet
Authorized State Agent 4/l-f��f� Date 04 111 (Zta lZ4