OPHTE# I I-5-4v�a4 Harnett County Department of Public Health24688
PERMIT# Z -q Dgeration Permit � /
New Installation Septic Tank L�YNitrirication line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I 16 Por. R.oc .>, C 5ti t3cf4
Name: (owner) 4Jt';Wr,6om &a&rs Tc . SUBDIVISION t_o,,x arr„nLK Hu/d co LOT # a
System Installer. C-eae. &cKbaoL, � c e- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well 14 feet
System Type: ZSj /Z� avc , 5';Z_4.^:: — Types V Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ibis system has been installed in compliance with applicable North Carolina General Scabnes, Rules for Sena a Treatment and Dispomt and all conditions of the Improvement Permit and Consvumon Authornoon.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 seewwsoisposal system on the above captioned property.
Type of system: ❑ Conventional LI Other 61- Septic Tank to gallons Pump Tang gallons
Subsurface No. of exact length width of depth of
Drainage field ditches _ of each ditch 150 feet ditches feet ditches f8 inches
French Drain Required: Linear feet
Authorized State Agent Date 11 130 1 ao1