OP RHTE# 1(' - 5 -vv U58 tZ Harnett County Department of Public Health 24823
PERMIT # LItb'y OiDeration Permit-- � �
New Installation eptic Tank l�Rtrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 52 t5c,5 S ;Iks F/ .- A -
Name: (owner) Si_a car_ It 61 d - -37n c SUBDIVISION 4,n4er s p6 r n4_LOT # 3q
System Installer: 5 C, I g Id, Registration #
Basement with plumbing: ❑ Garageupsherof Bedrooms
Type of Water Supply: ❑ Community f ❑ Well Distance from well feet
System type: 2 sio i2et L S 2s Types V and VI Systems expire in 5 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 Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
Anti:
13� 151
cal 1
90
16, I
?9
i
3b2 sr7l�
Po ua.r
PUMP -sp 9f'.J
't-FeA, 2 A (L A
11 16 14 ST A r>42J�> t> Z_
PERMIT CONDITIONS
I. 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 ❑
1120Line ❑ PWR Line
Following are the specifications for
the se��wage��d' posal system on the above captioned prose
Type of system: ❑
Conventional
f�Other C� F(�,+� 114—x, Septic Tank:
/43<gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
t of each ditch 3tv. feet ditches
3 feet ditches inches
French Drain Required:
Linear feet
Authorized State Agent Date III C–,5
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