OP RHTE# [L-5-z1a-10q2 Harnett County Department of Public Health 24946
PERMIT #a�— 6 Own Permit i
GYNew Installation peptic Tank L�-�Itrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION:y'{A'o Oc 4 VQJIJ .'rr—A 2a. (stL l�il
Name: (owner)�,l 1c. —t-_ SUBDIVISION LOT #
System Installer: Co--�- Registration #
Basement with plumbing: ❑ Garage umof Bedrooms
Type of Water Supply: ❑ Community L•F�Public ❑ Well Distance m well /O 2 feet
System Type: aS% AEA-13CA( tb0 Sas�j Cn Types V and A Systems expire in S years.
(In accordance with Table V a) —� Ownene sY� Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North. Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authortration
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PERMIT CONDITIONS: < _
I. Performance: System shall perform in accordance with Rule .1961. t 1 10
If. Monitoring: As required by Rule .1961. /
111. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage didi Pow yslem on the above oned
Type of system: ❑ Conventional I�Other {ic1( "c lgrope Septic Tank: I C—CO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 90 feet ditches 3 feet ditches QfIli inches
French Drain Reunited: Linear feet
Authorized State Agent Date
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