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OPHTE# 0-5409 Harnett County Department of Public Health 24671 PERMIT # Z'/X3 lveration Permi New Installation Septic Tanktion Line ❑ Repair ❑ Expansion PROPERTY LO[ATION: SS &e GE - (Ajk-;45 L4. s/Ils;,06) Name: (owner) I tf Cora, SUBDIVISION A Jk, L',//4 v LOT # P -;r System Installer: iJ li Registration # Basement with plumbing: ❑ Garageuer of Bedrooms 54 Type of Water Supply: ❑ Community 2"Aublic El Well Distance from well feet System Type: ZS% 4 1 L " -I 5 < ��,— 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 ha been installed in mmplianu with applicable North Carolina General Sutures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conmunion Authorintion. I� I 5,-D A �r C, > d FyY 2p G.� U w cti <6 PERMIT CONDITIONS: Performance: System shall perform in accordance with Rule .1961 Monitoring: As required by Rule .1961. 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�ggdisposal system on the above captioned pro erry. Type of system: El Conventional VOther ©c C"64— Septic Tank fol Op gallons Pump Tank 1,1s6 gallons Subsurface Drainage No. of G exact length 4B, vg, 58 width of depth of Field ditches of each ditch 5G,, b41, by Meet ditches _ 3 feet ditches /Q iwrhea trench Drain Required: linear feet q�— ..... Authorized State Ag H Date — �� `VW"