OPHTE# I-4 -s-41011 Harnett County Department of Public Health 24680
PERMIT # 2q 366 0 eration Permit
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Iew Installation Septic Tank 2--V�trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 141 sg nyto. 5E - C "kl;kae Ar ru, 5n. 1Al2-q)
Name: (owner) Winn QA5& gtr � -rAr SUBDIVISION Ave,A14 LOT #
System Installer: Thvvk:_,, s P1. v 4 : n Registration #
Basement with plumbing: ❑ Garage Z-116�mber of Bedrooms _
Type of Water Supply: ❑ Community [amu he 0 Well Distance from well n feet
System Type: z5`' 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 Totalled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all continues of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance:
Il. Monitoring:
111. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Fcc' a SIC Septic Tank: l a0o
gallons Pump Tank: N gallons
Subsurface
No. of
exact length width of
s
depth of
Drainage Field
ditches
of each ditch c;r,o feet ditches 3
feet ditches aO inches
French Drain Required:
Linear feet
Authorized State Agent Date _ I- 3/a6 / <3 6 t
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