OPHTE# I I-5 -q Wc7 Harnett County Department of Public Health 24932
PERMIT # 2CtM_ 0 eratFon Perm'
E�Ifew Installation Septic TankNitfs rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 315 A.e e6lc Dr t7i"eSAv 1 5rz I r;
Name: (owner) �n5� ��� 1K SUBDIVISION Aa je cc) AA LOT # LIC)
System Installer. nj#m
Registration # `J
Basement with plumbing: ❑ Garage r BedroomsType of Water Supply: ❑ Community ❑ Well Distance from wellset
System Type: R, %, /lo.C.c i , �� ypes v a vl cr ns expire in S years.
(In accordance with Table V a) wner st contact each Department 6 onths prior to expiration for permit renewal.
has been installed in compliance with applicable Nonh Carolina General Statutes, Ruin for Sewage Treatm nt and Disposal and alllronditions of the Improvement Permit and
poems
50 S tSkcX—
aSYo ti��.
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No p�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D•Box ❑ Pump ❑ Alarm ❑ 42OLine ❑ PWR Line
Following are the specifications for the sewage d� t�
isPosaI system on the above caQti
Type of system: El Conventional 9-1—her g nSeptic Tank: I of Sc gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch c �ci feet ditches 3 feet ditches Qil- inebee
French Drain Required: linear feet
Authorized State Agent Date c��3;I` ;k>12-