OPNTE# (7-5 -4 a4o!4 Harnett County Department of Public Health 24927
PERMIT # I motion Permit ,—
L -T New Installation ❑" Septic Tank E?"Witrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t'r ,.as, fL'5.�Ic.1\v- rs ` Z P'a&
Name: (owner) rY�.a SAc3x4ps SUBDIVISION d �% LOT # '2a
System Installer: T¢b owel Registration #
Basement with plumbing. ❑ Garageumrb c of Bedrooms 3
Type of Water Supply: ❑ Community E+-Tublic ❑ Well Distance from well t� feet
System Type: QS%,/'u2A�_yn 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 immlled in compliance with appliable North Carolina General Statutes, Rules for Sewage Treamuni and Disposal, and all conditions of the Improvement Permit and Conumcoon Autheriarion.
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PERMIT CONDITIONS: Co%
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 di system on the above captioned ,ro e
Type of system: ❑ Conventional cher QG1K. rvsl a �c \ \ 1n Septic Tank: (r YO gallons Pump Tank: 100ED gallons
Subsurface No. of2 exact length �FF width of depth of
Drainage field ditches 3 of each ditch W feet ditches '3 feet ditches e9� inches
French Drain Required: Linear feet
Authorized State Agent �� /�J/% ��� /0r— Date C)'410RIa010
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