OPHTE# 11 -, Harnett County Department of Public Health 24720
PERMIT # Zc) 4q5 Weration Permit
New Installation peptic Tank on Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ec7 6,4-., or. [ old 54r� �74. s't'c&'sA
Name: (owner) wex\coos M�,�c SUBDIVISION oxFc a�� �� LOT # ay
System Installer: Cva- A Registration #
Basement with plumbing: ❑ GarageNu�m r of Bedrooms 3
Type of Water Supply: ❑Community I�blic ❑ Well Distance from well ^' feet
System Type: Y 5 C. _ /t x a tic,7 ^ 5—is. � 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 appliable Rorth Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (onstmttion Authorization
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 oral system on the above captioned aroaem
Type of system: ❑ Conventional her iFX:1:* ' Septic Tank gallons Pump Tank gallons
Subsurface No. of exact length 5 width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Date
Authorized State Agent i t t �'� l�
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