OPHTE# i�-s-'� Harnett County Department of Public Health 24831
PERMIT # '� `1s-13 0 eration Permit �
New Installation �c Tank 43— itrification Line ❑ Repair ❑ Expansion
7S& za PROPERTY LOCATION: 'a,99 Puu , �r� e.r4�11s 2d. �s2 0e]
Name: (owner) Nr,a ,, t—u SUBDIVISION LOT #
System Installer. (f,);Ak AbcrKs Registration #
Basement with plumbing: ❑ Garage cher of Bedrooms 3
Type of Water Supply: ❑ Community CYPFb` ❑ Well Distance from well N4 feet
System Type: 'dS'i„ ;-�k `2 Types V and A 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 applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. 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
.�tEE+Fr2 Fva�
Following are the specifications for the sewage sal system on the above captioned property.
aa'
❑ Conventional Other
E C C,
Septic Tank: gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ly„ On/tT eiEW,1�'�E
f f
r'-
irn tear{¢ -d lwwr
1 134
IS'II55'' lel
3bt s cam
,
n�
,L
tv
0
PINEY Gt. If— /j,A.JLs 2%7
Cva-fW
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. 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
❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage sal system on the above captioned property.
Type of system:
❑ Conventional Other
E C C,
Septic Tank: gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 3
of each ditch tyo feet
ditches 3 feet ditches �'� inches
French Drain Required: Linear feet
Authorized State Agent DateIl I� GIQ�
I t
ri � a
i �
Y
f r W
y.tpti i � I
1 },