OP RHTE# l'I-s-vIBtOi(L Harnett County Department of Public Health 24963
PERMIT # a 9;4 /v enation Per '
New Installation �
Septic Tank ttrlfication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: IS PIMP 5E4-E.c, fLi . (6W S&.,se ti.. sa. v -X
Name: (owner) V -Io rrmcl %Asj.gm-:! SUBDIVISION 2 veccao LOT # S-
System Installer: Gvc Registration #
Basement with plumbing: El Garage BedroomsIYL
Type of Water Supply: ❑ Community 13 -'Public ❑ Well Distance from well "J"or feet
System Type: 26X> S. Types V and A Systems expire in S years.
(In accordance with Table V a) 0 er must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Stamm, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authoritarian
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage ' Dial system on the above captioned to rty. Type of of system: ❑ Conventional Other - �—�a.�a �o, �%' Septic Tank: 1gallons Pump Tank: gallons
Subsurface No. of exact length J width of depth of 11 //--
Drainage Field ditches of each ditch �eS feet ditches --s� feet ditches � inches
French Drain Required: linear feet
Authorized State Agent Date (:!-,5 LM 016