OP RRHTE#_ Harnett County Department of Public Health 24149
PERMIT # Opefation Perm' ,�__��
New Installation Septic Tank LNltrlflcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3f.G K AA ll
Name: (owner) k)(�& -.!i-urn SUBDIVISION C.a�p4�_ LOT # VL
System Installer: ' FV'0-�cr�h 5, Registration #
Basement with plumbing: ❑ Garage um �f Bedrooms
Type of Water Supply: ❑ Community f ublic ❑ Well Distance from well ^�''� feet
System Type: a5cfi Types Y 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.
MS system hm heen installed in comphance with applicoble Norah Carolina General States, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consmuction Authorization.
9a' nib'60 Sr�SPr��ec�
aaICFtlls3
0 t -35o s T Ag�E I-�ra
\G,(-r'f�
t c)`411-4- 1
HE—
Lid — —
c ' Iii
4Y5p 5rr7 P
m ta'
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage �dis '�Ystem on the above captioned roperty.
Type of system: ❑ Conventional Z, Fther Ex 'Pias, Septic Tank: I 00(!> gallons Pump Tank: tQq'), gallons
Subsurface No. of` II exact length width of depth of
Drainage Field ditches i of each ditch S feet ditches feet ditches aQ inches
French Drain Required: Linear feet
Authorized State Agent / Date bq I I- aol
-Al r
V