OPHTE# 11 -s - N 13 b0 Harnett County Department of Public Health 24707
PERMIT # Z C/ q 7'6 Owmtion Permit
ew Installation eptic Tankil trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1�., _ CciA56,4-. , sa a.
Name: (owner) C r,wCursl= =:, SUBDIVISION C>A a -A LOT # �
System Installer: tZ \ q> j2 S Registration #
Basement with plumbing: ❑ Garageumm, of Bedrooms 3
Type of Water Supply. El Community C blit ❑ Well Distance (r m well ti feet p"5' IGS bX4orcA k')�� t>—,
System Type: z 5% A c_ c ,L `r n Types V and VI Systems expire in S 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 apdicable North Carolina General Statutes. Rules for Sewaee Treatment and Disposal. and all condirinns of the Imnrawrrm Permir and rnn.minlnn R,ahndnunn
s
D -Box
—
Alarm ❑ H2OLine
4 Wa d
Following are the
5zL L 3)
the sewage sal system on the above captioned property.
,11 P., nEna1
�I
18�
❑ Conventional
Other CJ �{ G�Ciwtl-xs^�_
Septic Tank: t [X'Y gallons
ZSy M1n�p
Subsurface
3B2 St=t� ��eorq,
exact length
3
width of
depth of
I
I
_
c,Xr a _o wc0 S �2 •
ditches feet
ditches a4 inches
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for
the sewage sal system on the above captioned property.
Type of system:
❑ Conventional
Other CJ �{ G�Ciwtl-xs^�_
Septic Tank: t [X'Y gallons
Pump Tank: � gallons
Subsurface
No. of
exact length
3
width of
depth of
Drainage Field
ditches
of each ditch 4-61 feet
ditches feet
ditches a4 inches
French Drain Required: Linear feet
Authorized State Agent fJ5 Date 12t 121 aC> I--i-
L
Kim
ILWO
mr,olm