OP RHTE# )1-6-q)s172 Harnett County Department of Public Health 24947
PERMIT # a9559 emtion Permit �, ��--
New Installation eptic Tank L.Y..Mttrdlcatlon Line ID Repair ❑ Expansion
c �'�.7 8 Q4i �i C Z, S PROPERTY LOCATION:—11:!j (AWe, (Lo<c= (&5
Name: (owner) 2a 1, .S Ph ,'Its :���SUBDIVISION LOT #
System Installer.1.NN.b s Registration #
Basement with plumbing: ❑ Garage umber owe moms �—
Type of Water Supply: ❑ Community Ld�P(b ilc ❑ Well Distance from w II il-�64ti feet
System Type: 'a 65 (7� .> L.n n 5 c Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner in contact Health Department 6 months prior to expiration for permit renewal.
this system has been imtalled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS: L
rmmITudna: sysaem span perrorm to accordance with Kole .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 -Boz ❑ Pump ❑ Alarm ❑ H2OLme ❑ PWR Line
Following are the specifications for the sewage d''Wesal system on the above captioned ro e
Type of system: ❑ Conventional CYbther &&L Septic Tank:'5n gallons Pump Tank
hgallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent�Tl�%��?lt�� �� �✓Ili�s Date 64C/� 190 )&,,