OPHTE# II - 5 -'4 2'4 Harnett County Department of Public Health
24144
PERMIT # a5ayo 0eration Permi ��
New Installation Septic Tank E;-'frtrduation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: %34 S as P Ln 4aad Tata. a 21 .5f.t4R/�
Name: (owner) S+ nab., a iia 31ds SUBDIVISION SMS LOT # 15-
System
$System Installer. �a c1G6o ,,i Registration #
Basement with plumbing. ❑ Garage lumber of Bedrooms
Type of Water Supply: ❑ Community El-FiZic— ❑ Well Distance from well e.rA feet
System Type: a 5 v o n S s LYM types V and VI Systems expire in S years.
(In accordance with Table V a) Owner ust contact Health Department 6 months prior to expiration for permit renewal.
This system has been inmlled in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorintion.
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PERMIT CONDRIDN4
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ PWR Line
Following are the specifications for the sewagedimes sal system on the above captioned�ro e_rty.
Type of system: ❑ Conventional f�Other 7 '� t`"t � t Septic Tank: s (-c)0 gallons Pump Tank: gallons
Subsurface No. of exact length n width of depth of
Drainage Field ditches 3 of each ditch I feet ditches � feet ditches a'C—' inches
french Drain Required: Linear feet
Authorized State Agent Date 1 QG 1 olUyg
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