OPHTE# ��-5-yogt� Harnett County Department of Public Health 24840
PERMIT # A 9355 QDeration Permit
mew Installation [Septic Tank kation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ao Do+ a /Afa:,s 1, 5—
Name: (owner) 2�ty 0 oaKs elA .� e SUBDIVISION A f5l r LOT # 3Ei
System Installer. Registration #
Basement with plumbing:
El umber of Bedrooms —�
Type of Water Supply: ❑ Community l�c ❑ Well Distance from well - 'A feet
System Type: �5% /"",on S,s.' /Ir 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
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 -Boz
❑ Pump ❑ Alarm ❑
H2OUne ❑ PWR Line
Following are the
specifications for
the sewage osal system on the above captioned roperty.
Type of system:
❑ Conventional
Other 4Q GGtawS�s- _T1�L�s Septic Tank:
t!: -:C> gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
S
depth of
Drainage Field
ditches
of each ditch feet ditches
feet ditches �//,,�� inches
trench Uram Required: Linear het
Authorized State Agent �� �` Date