OPHTE# I (o- S - 39od1 Harnett County Department of Public Health 24645
PERMIT # LqbW DWation Permi
New Installation Septic Tank rtfication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5 -y - C A rt a Nz9
Name: (owner) W i nn C'or\S, fU (""-sN :3 r, SUBDIVISION LOT # '3-2-
System
2System Installer: u r a Registration #
Basement with plumbing: ❑ Garage � lcM of Bedrooms
Type of Water Supply: ❑ Community IsVPublic 13 Well Distance from well feet
System Type: Al d"Ie—&cn S . � r Types V and VI Systems expire in S years.
(In accordance with Table V a) wner 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, Auks for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
1. 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 �dis �sy�js %Em on the above captioned property.
Type of system: ❑ Conventional I�YDther %C /ate �— Septic Tank: / ZGY3 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z— of each ditch feet ditches 3 feet ditches 2S inches
French Drain Required: Linear feet
Authorized State Agent Date Ov f4 1 261--f—
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