OPHTE# 15 -J Harnett County Department of Public Health 24690
PERMIT # 7-16J`I6 Uaeration Permit
C"New Installation 2'Septic Tank cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: IM, C1ric,4,can lc -a. (S/t ty'7)
Name: (owner) Doi crk A. o c rAonc� SUBDIVISION LOT #
System Installer icon. c.ts.., Registration #
Basement with plumbing: El Garage ❑ Number of Bedrooms 114
Type of Water Supply: ❑ Community Inc ❑ Well Distance from well feet
System Type: 25% iL,-A s .X11 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 sysum has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 disposal system on the above captioned property.
Type of system: ❑ Conventional Iffier r;;- GZ— -"'» Septic Tank: I gallons Pump Tank gallons
Subsurface No, of exact length �— width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches 2t4 inches
French Drain Required: linear feet
Authorized State Agent l✓-fs Date v/aa/aoT-4-
Lidlh
'No
V-)
no