OP RHTE# 1 -s-4 L ii2 Harnett County Department of Public Health 24958
PERMIT # y_�C eration Permit---� �
New Installation Septic Tank 211itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I(d`) F kuc- Ln i '4 ill, sQ rgo$j
Name: (owner) "Tr. C4cc , SUBDIVISION LOT # d
System Installer.mer n iL g Registration #
Basement with plumbing:
ED Iuof Bedrooms '7
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well 100+ feet
System Type: 6� , sTypes V and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
has been installed in compliance with applicable Noah Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
u
I
1 (L.t-QasZ AC1z-sA aS"—►
��'� I It F9' Portcu
c�� X 3bt
3t D 38rz Sv
;ri 6 � Pvar�sa
197
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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned ptopee
Type of system: ❑ Conventional GY6ther r 7, '� 10 —CC k, Septic Tank: it—jCr gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch 4-6 feet ditches 7 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent i Date
�
�
C
�
3
�
�
7
'�
Q
�
�
�7
`'
�. :'
Jf SI)
i(' � � '_i,�,,
r
Y' •;.
'•''� : r!
�. we ;y
r ;�,dM!
�,:' '