OPHTE# I�-S �aapp Harnett County Department of Public Health 24937
PERMIT # 2`1933 Dwation Permi �
lew Installation Septic Tank 0 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3q M,,AyfN Lf 8x;c4' mm (Lot. 5a�
Name: (owner) Oo.c\u T-Y&L HofAo SUBDIVISION LOT # (So
System Installer. nb; Registration #
Basement with plumbing: ❑ Garage E er of Bedre ms q—
Type of Water Supply: ❑ Community L� Public ❑ Well Distance from well ''j�" feet
System Type: ✓ ti c"_ Types V and A Systems expire in S years.
(In accordance with Table V a) Owner mus act Health Department 6 months prior to expiration for permit renewal.
[his system las ben installed In compliance with applicable Nonh tamlina General Statutes, Ifules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
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 ❑ H2O1-ine ❑ PWR Line
following are the specifications for the sewage dis as ystem on the above captioned_�roA�rty.
Type of system: F-1Conventional S.1 a _ \1LI Septic Tank: lQ� gallons Pump Tank gallons
Subsurface No. of exact length width of depth of s-�CG�
Drainage Field ditches + of each ditch �� feet ditches 3 feet ditches NG inches
French Drain Required: Linear feet
Authorized State Agent Date 0;3 /go L;Ele->
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