OPNTE# f'4 - S - yiq'a Harnett County Department of Public Health 24824
PERMIT # a°139Owation Permit �
eco Installation Septic Tank f1Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: P0'a ee<c o wt,s ./c rza S2 yr
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Name: (owner) rim COnS��Jt y '„� Tnc . SUBDIVISION A..3 .-� ao J I LOT # 49
System Installer: PA Q -Aka• nx Registration #
Basement with plumbing: ElGarage 11- 1amber of Bedrooms y
Type of Water Supply: ❑ Community 1;—Pu2—c ❑ Well Distance from well feet
System Type: ab°— Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wner 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 Constriction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
D. Monitoring. As required by Rule .1961. j
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Er
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box Cl Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwage�dis sal system on the above captioned ro�erty.
Type of system: ❑ Conventional LHS Other �� F/9 uJ -7 1 Septic Tank: f cZ60 gallons Pump Tank: gallons
Subsurface No. of ^ exact length width of depth of
Drainage Field ditches of of each ditch O O feet ditches 3 feet ditches 2d inches
French Drain Required: linear feet
Authorized State Agent Date ti 1 d0, / eLr�j—
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