OPHTE# II - s yaGsU Harnett County Department of Public Health
24143
PERMIT # a rid s s ration Permit��
New Installation eptic Tank LNitrification Line ❑ Repair ❑ Expansion
Lo^y N• PROPERTY LOCATION: 50 fSrssovleoa
Name: (owner) ScuvlP>s To,csKsc.n SUBDIVISION t6T #
System Installer: Cop ag Sach!Q>w,Registration #
Basement with plumbing: ❑ Garage 9umber of Beckon 3
Type of Water Supply: ❑ Community El Public L�Well Distance from well I tJC�!, feet i"
System Type: d S "c- c.r, , 11 L—'— Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner m6sli contact Health Department 6 months prior to expiration for permit renewal.
1j, lylwol uao Peen insrmmo in compnance wun appocanle norm taronna weneral Statutes, eines for Sewage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
aqt I s31
ISI
302 So�r7
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
900 Af4y Tb+
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Subsurface system operator required? Yes ❑ No L3�-
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 sewage df�isposal system on the above captioned roperty.
Type of system: ❑ Conventional %sem In -1 OSeptic Tank: I0C-)C-;s gallons Pump Tank:gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Co U feet ditches 3 feet ditches R2 41 inches
French Drain Required: Linear feet
Authorized State Agent Date
V)