OPHTE# I1-6-104-Acy, Harnett County Department of Public Health 24870
PERMIT # a 5563 Owation Perm'
New Installation Septic Tank 9-1—trification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 35 Sw=,n C.n. (&g L. ue a:d . Sn, Io5cc
Name: (owner) k:e nme6, SUBDIVISION Pow "VQ-- LOT # h-4 R
System Installer. We-,, a5S Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms —1
Type of Water Supply: ❑ Community 14"Fabric ❑ Well Distance from well N A feet
System Type: 'R*- i s - "7 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 hu been innalled in mmpliana with appliable Nonh Carolina General Stamm, Rules for Smage Tmatmem and Disposal, and all condinom of the Improvement Permit and Conswttion Authorization.
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961. d c s ,e C tom fres S rCr
As required by Rule .1961. >
As required by Rule .1961. Other.
Subsurface system operator requiredt 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 di sal system on the above captioned property.
Type of system: ❑ Conventional L7%ther Q4 c s cwS `FEZ Septic Tank: LCXx=> gallons Pump Tank: gallons
Subsurface No. of 4— exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: linear feet
Authorized State Agent/ ' X145 Date <n I I ayI ao143
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