OPHTE# Harnett County Department of Public Health 24638
PERMIT # Z-9Z6f` beration Permi �
New Installation "tic Tank ❑1�trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: .251 Oof. (&JW4 a..s. 6ec Ia?7)
Name: (owner) Sync;/ B.rldess s a . SUBDIVISION oo,C)kr e �I- LOT # Yz
System Installer. / #st,r feta Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community "blic ❑ Well Distance from well feet
System Type: Z55a nzA,X-4.;C"% S*s. ; 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.
II. 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 ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal
�
system on the above captioned—fro-perry.
Type of system:
❑ Conventional f�Other
E� Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
3
Drainage Field
ditches 3
of each ditch IUCD feet ditches
feet ditches 7-4/- inches
French Drain Required: Linear feet
Authorized State AgentDate���1�—
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