OPHTE# 1-4 -s —404351 Harnett County Department of Public Health 24846
PERMIT # a 4339eration Permit
New Installation < Septic Tank tion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:304 1 yMnorn rzA . C 52 1433)
Name: (owner) Sc oaea -Ir- S,:gNy, SUBDIVISION LOT #
System Installer: NN,rADc% Ex<s 6njk Registration #
Basement with plumbing. ❑ Garage u f edrooms 3 +1
Type of Water Supply: ❑ Community ❑ Well Distance Ir well ^,A feet
System Type: 'd5%arteda4ton �,K .n !� Types V and VI Systems expire in S years.
s er
(In accordance with Table V a) Omust contact Health Department 6 months prior to expiration for permit renewal.
this system has been Installed in Compliance with appliabie Ranh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
TO a5$o neo.-.cz�o•a ��G[,,
riGnAs2 Asc r� 'd,'/
sr/ 5 V CMy;A NO V`^Y
a ' ayo Goo s—�>
tf%'•l No s3 edr Way`.
P
3aA-
Ss=9
6Wse.d -
20 Cs,. luaa�
t( O«,tsG,�ay
rcnnu Lunull ulO:
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 -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above cape ioneedd roperty.
Type of system: ❑ Conventional E;- Y Bier Septic Tank: 16CX>_ gallons Pump Tank: gallons
Subsurface No. of exact length 5 width of depth of
Drainage Field ditches 61of each ditch feet ditches 3 feet ditches t5? L9 inches
trench Drain Required: Linear feet
Authorized State Agent Date Date 1(I 3y l a of
r