OPy P 24866
HTE# ) �--5--z4 N4tD Harnett Count Department of Public Health
PERMIT # ° 5 6 Qwation Permit _
LYNew Installation tic Tank 0-1Ntt station Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: fso e 4bn I>,- LGIA Sfax
Name: (owner)C , n ,,� No car. ; ne SUBDIVISION o x %Zcz�� LOT # 3
System Installer. Registration #
Basement with plumbing: ❑ Garageuof Bedrooms I
Type of Water Supply: ❑ Community LdiPublic ❑ Well Distance from well �%r feet
System Type: al 5% 2r a JL4 In n Sof' . --,ZZZ:V-J 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 applicable Norm Carolina General Stamens, Rules for Sewage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
1=4 TON
C
/ D
3
PIT
n\ s�o a.p C.3i I
� yeAcc� I
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 osal system on the above captioned prgQerly.
Type of system:
❑ Conventional EeOther
0 I C V orary
Septic Tank s nN gallons Pump Tank: i 6c -G gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch
feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent /" ��� /� Date va/a�/acJ�i