OPHTE# L j —5-gt,6Gq Harnett County Department of Public Health 24626
PERMIT # 25 3W 0 eration Permi
New Installation Septic Tank �rification Line ❑ Repair ❑ Expansion
,1 PROPERTY LOCATION: 6) r G,vAK r. til s 59 /n IV
Name: (owner) ComCc>r- r�ManA,&, TN, SUBDIVISION �rnSs L,�s1C P)ca�_o LOT# t
System Installer, u55e\1 (47i11I Registration #
Basement with plumbing: ❑ Garage � 1�1u*r of Bedrooms
Type of Water Supply: ❑ Community EV Public ❑ Well Distance from well feet
System Type: 7 5 ` 2eA x f n 5. s 7iiTZ; 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_ Treannem and Disposal, and all conditions of the Improvement Permit and Constmcdon Authorinfion
PUMP To 25j.
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PERMIT CONDITIONS
1. 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:
V. Other.
❑
D•Box ❑
Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the
specifications for the sewa �a isposal
system on the above ca boned property.
Type of system:
❑ Conventional 13' Other
Septic Tank t (XI0 gallons Pump Tank 1600 gallons
Subsurface
No. of
4-
exact length
width of depth of
Drainage Field
ditches
of each ditch L6 feet
ditches 3 feet ditches inches
French Drain Required: Linear feet
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