OP RHTE# 17-5 -<&,-42 Harnett County Department of Public Health 24956
PERMIT # 9graton Permits
2' New Installation C9,1eptic Tank C;-Artriffcation Line ❑ Repair ❑ E
PROPERTY LOCATIONAVI 2"�\ (S2
Name: (owner) 3e-r)et,,t,.,e hl+c48e.QVzQ,-r& SUBDIVISION LOT # 7
System Installer: Alex Mass Registration #
Basement with plumbing: ❑ Garage ❑ Numb Brooms
Type of Water Supply: ❑Community ublic ❑ Well Distance from well av4 feet
System Type: S- Types V and VI Systems expire in S years.
(In accordance with Table V a) 'Wer must contact 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 Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 dpi °sal�sysSem
on the above a boned rty.
Type of system: ❑
Conventional L-I�Other
C sJ`[
CIN04*
Septic Tank gallons Pump Tank: gallons
Subsurface
No. of
exact length
U
width of depth of C� �-�S
Drainage Field
ditches
of each ditch feet
ditches feet ditches �V''GY'-inches
French Drain Required:
Linear feet
Authorized State Agent / 1//�� Date ,q) P" aut?