OPHTE# l- -s-yam cv Harnett County Department of Public Health
24139
PERMIT # ati 3w� eration Permit
New Installation Septic Tank tion line ❑ Repair ❑ Expansion
PROPERTY LKATION: i bb> C%�It.\, t;_r
Name: (owner) +- 0 :o tto SUBDIVISION �VK LOT #
System Installer: A(A'wo 3Qty —) C.r^cc nc Registration # 2Ll S
Basement with plumbing: ❑ Garage ❑ N er of Bedrooms 3
Type of Water Supply: ❑ Community c ❑ Well Distance from well ^-' ca feet
System Type: a5 i. n a {;o < aTypes V and VI Systems expire in S years.
(In accordance with Table V a) Owner --must Health Department 6 months prior to expiration for permit renewal.
mis system ha been installed in Compliance with applinble North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all tondidons of the Improvement Permit and Conswction Authonaation.
BSYk, 62v.(no.]
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PERMIT CONDITIONS:
I. Performance:
It. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961. V
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No I'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alorm ❑
Following are the specifications for the sewage disposal system on the above caption roperty.
Type of system: ❑ Conventional fuer Septic Tank: I
Subsurface No. of exact length width of
Drainage Field ditches °� of each ditch t a0 feet ditches 3_
H2OLine ❑ PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches 26 inches
French Drain Required: Linear feet
Authorized State Agent Date ' 1 11G a a 1 8
was
V,
7."