OPHTE# 11-5 -14011 Harnett County Department of Public Health 24964
PERMIT # a 9 alb eration Permi
New Installation eptic Tank Nitrification Line ❑ Repair ❑ Expansio
PROPERTY LOCATION: R98 A 61i -zs,A l,n . (yc,�a G5 145_ &L IS
Name: (owner) U a W, SUBDIVISION LOT #
System Installer: ;ry_ 0h11 Registration #
Basement with plumbing: ❑ Garage [9-1 u_mbr rooms ,
Type of Water Supply: ❑ Community uC�P"blic ❑ Well Distance from well ^iDr feet
System Type: 5 a Types V and VI Systems expire in S years.
(In accordance with Table V a) 0 must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in
General Statutes, Rules for Seware Treasurers and
Z'% N
�Vo�
C'-IFCa s 2
t:rtia,
2
and all conditions of the
b/
PERMIT CONDITIONS:
1. 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.
Lam
i t> (I al%-3LI NJF:5
IIFT of r
� TAcvFC $.5.T
Ott SFp
x- l L(— Tc� MQte:`i;;:_
l�iTti Ttl,ENe,r..l.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage d' system on the above captioned property.
Type of system: ❑ Conventional ther O `I C1Nr- VAx-- Septic Tank: fy<kA gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch g� feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date 0SlCF1 I aC_)tce>