OP RHTE# `LiauQ>,2 Harnett County Department of Public Health 24966
PERMIT # eration Permi
New Installation eptic TankitL�N rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 2116 6z,.�d\E Lam. Cgf"Ie -:Y&A<n C%n
Name: (owner)6—,(s Nn c_ SUBDIVISION LOT # f
System Installer: vcu clthvrI 3— Registration #
Basement with plumbing: ❑ Garage � ry�� ''r of Bedrooms
Type of Water Supply: ❑ Community L�' Public ❑ Well Distance from well c -JA, feet
System Type: R 6`o A Types V and VI Systems expire in S years.
(In accordance with Table V a) --twiner 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
YtRNII lUNunlDns:
I. Performance:
II. 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 -Box ❑
Pump ❑ Alarm
❑ H2O1-ine ❑ PWR Line
�ICFxVti Y,I
QNE 1-4 1
Type of system:
/s/
N�J6 QxYw
Septic Tank: i M! )gallons Pump Tank: gallons
47EA
� (✓ � I � I
�; SYST�r� 11,E ocr 5'-a�
exact length '-}/j„45,45, qG
q,l,11
fL�,, t a a tt1Z
ditches
of each ditch 4r g�?,S feet
ditches c3 feet ditches inches
1n1
�
PX( Myr•.`
y5i
q61 11`
tnSRT 2 Lt Ne'` Akk /F,::jvk`,p,�
yi3 +Y)
4 -C -L7 )tdTc:v i
2=Piat�Z-
3fl2
III S`a P��.p
2 t1r=u�yL
v �
YtRNII lUNunlDns:
I. Performance:
II. 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 -Box ❑
Pump ❑ Alarm
❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage doi osal system on the above captioned property
Type of system:
❑ Conventional F3�Other
N�J6 QxYw
Septic Tank: i M! )gallons Pump Tank: gallons
Subsurface
No. of
(50
exact length '-}/j„45,45, qG
width of depth of
�
Drainage Field
ditches
of each ditch 4r g�?,S feet
ditches c3 feet ditches inches
French Drain Required: . Linear feet
Authorized State Agent
I