OPHTE# i b-6—401eZ Harnett County Department of Public Health 24647
PERMIT # 25 Z eon on Permlt
New Installation Septic Tank C�itrifiwtion line ❑ Repair F-1 Expansion
Andj sjh"UC- PROPERTY LOCATION: SLI-46'7)
Name: (owner) (Lusxll —Pr1. ri 1 r3 SUBDIVISION Pric,&lc, C—rs-Lc. LOT #
System Installer. Rett 1A QIICXMA Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Z 5 i 1`""C.s 0 53,A . 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.
mis system nas need installed in mmmunce wdn aouncame norm Lars henerai
TO ot'b� Sxt{(ov_
211 5 .
suits tar sewaFe Treatment and dWosal. and an conditions of the
3432 s Fz�,
I. Performance: System shall perform in accordance with Rule .1961.
11. 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:
Y. Other.
f loiq Stnl Cover exap;aL(,a
-lN r� -+ A-" 6-
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage * posal system on the above captioned property.
Type of system: ❑ Conventional Other GY n6Cr ' Septic Tank 5000 gallons Pump Tank gallons
Subsurface No. of exact length IS. Z e 46, width of depth of
Drainage Field ditches of each ditch 69,311,115' feet ditches 3 feet ditches iZ-16 inches
French Drain Required: Linear feet r(tkt u)"a Fite
Authorized State Agent-�,z / Date
IC s
i
fif:•,