OPHTE# -ut74a Harnett County Department of Public Health 24856
PERMIT #a1 `f G�tiCT 0 ation Permit
ew InstallationepC S ptic Tank1l�g16 lcal n Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W L1�eckx CE Coif SFr,c� 2 tCy�
Name: (owner) oroC.r-- SUBDIVISION 01.1-% i LOT # 36
System Installer: i2 os P Registration #
Basement with plumbing: ❑ Garageum er of Bedrooms :7
Type of Water Supply: ❑ Community Erluublic ❑ Well Distance from well ^'R feet
System Type: 2<7 "� [-' 75 'Lj� 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 instilled in compliance with applicable North Carolina General Statutes, Rules for sewage Treatment and Disposal, and all conditions of the Improvement Permit and Comwnion Authomafion.
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PERMIT CONDITIONS
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No L'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage sal system on the above captioned prope ty
Type of system: ❑ Conventional Other fig C rXXA6— Septic Tank:
Subsurface No. of exact length �— width of
Drainage Field ditches t of each ditch Ra '6 feet ditches -
French Drain Required: Linear feet
Authorized State Anent _✓ f mss-� �_.�r�
H2OLine ❑ PWR Line
tt>m gallons Pump Tank: gallons
depth of
3 feet ditchesinches
Date S atol la�l�