OP RHTE# ll -5-4145,3z Harnett County Department of Public Health 24142
PERMIT # a`I 5C -y ration Permit_
Rr New Installation 2 Septic Tank Cel,Aitrificatioo Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ 3tlff S-t,63-k� co�!a za, Csn Issr)
Name: (owner) Su.,-no,tk , Y„t_c- SUBDIVISION LOT #�
System Installer: 5-ecw�.\ gJA4- Registration #
Basement with plumbing. ❑ Garage umber drooms -:T
Type of Water Supply: ❑ Community ptZlic ❑ Well Dis ce from well '--' feet
System Type: a5` c� ,\ Types V and A Systems expire in S years.
(In accordance with Table V a) miner must contact Health Department 6 months prior to expiration for permit renewal.
ton system has been mstaned to complmna mth applicable Norah Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and commission Authorization
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I. Performance: System shall perform in accordance with Rule .1961.
IL 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 ❑
Following are the
specifications for
the sewage'disperial system on the above captioned LM-Kity.
Type of system:
13 Conventional
f3'Other 11-� �s o a 4L\_:,
Septic Tank: spa gallons Pump Tank:
Subsurface
No. ofexact
length
width of depth of
Drainage Field
ditches
3 of each ditch �30 feet
ditches 3 feet ditches
french Drain Required: Linear feet
Authorized State Agent Date 1 a 4 LaOt0
PWR Line
gallons
inches