OP RHTE#Harnett County Department of Public Health 24969
PERMIT # a 5`i 2rflOn Permit----
L2'
erms l�N
New Installation eptic Tank itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ loos tJ e; ll5 Lrr ee 2A . /S ¢. (SL
Name: (owner) Rr-a,Lk-- 1,k4- w 6 SUBDIVISION 1Z ., rs L n4e-(1no s/n LOT # I
System Installer: jig le,c Mn 5 Registration #
Basement with plumbing: ❑ Garage ❑ Npmberof Bedrooms .3 C-P�T\>7
Type of Water Supply: ❑ Community [? Public ❑ Well Distance from well n/ A� feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Ow ust 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
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 ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage fispossil system on the above captioned FiT21%
Type of system: ❑ Conventional f Other C,34 G���6'— �T1\ Septic Tank: 11, gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 1'
Drainage Field ditches of each ditch 9a> feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date o5 I It Iaa'R,
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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 ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage fispossil system on the above captioned FiT21%
Type of system: ❑ Conventional f Other C,34 G���6'— �T1\ Septic Tank: 11, gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 1'
Drainage Field ditches of each ditch 9a> feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date o5 I It Iaa'R,