OP RHTE# I(0'5-3'ug2 Harnett County Department of Public Health 24839
PERMIT # a4Lloe' Deeration Permit
New Installation Septic Tank cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ao ste sc"y-, su . (aC0Ens Q? . C; tyt3)
Name: (owner) tJ .E.eWor-.axs SUBDIVISION (ze--ctNke_ LOT # If
System Installer. P .E, . G. -.a— — Registration #
Basement with plumbing: ❑ Garageum�Bedrooms
Type of Water Supply: ❑ CommunityuC9 P blit ❑ Well Distance from well feet
System Type:^sy_ Types V and A Systems expire in S years.
(In accordance with Table V a) J 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
a6i� 'Leaocr-,.
8� 's,a45sceau6') -�
4
oc�v(av:�� �
�HA^^:Jz
�b _ 43eC3) Al
�i � s -ll y j
J
0
33 2
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. 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:
Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewagel-�04posal system on the above captioned property.
Type of system: ❑ Conventional 2�Other /L3CV Gl a a1�{ � Septic Tank: A d� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch Cc�� feet ditches 3 feet ditchesA�, - inches
French Drain Required: Linear feet
Authorized State Agent Date
41