OPHTE# f S-43a� Harnett County Department of Public Health 24972
PERMIT # Qwation Permit
New Installation eptic Tank ttrification Line ❑ Repair ❑ Expansio
Soc7ctA:�%catl V'ecWv— PROPERTY LOCATION: 3090 CA& - ( Sec I
Name: (owner) WcArIt C,etti�� SUBDIVISION ULOT #
System Installer ko t -GlcN 5tx;C .ale. N; Registration #
Basement with plumbing: ❑ Garage ❑ 1of Bedrooms 7—
Type of Water Supply ❑Community ublic ElWell Distance from well ^-)P, feet
System Type: 1 S � % , Types V and VI Systems expire in 5 years.
(In accordance with Table V a) UU Owner mos 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.
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PERMIT
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PERMIT CONDITIONS:w I
1. Performance: System shall perform in accordance 1116.1961.
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.
TO O L t> STAB 2 � vD,
Sc'1_. SOcy;
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewaged' system on the above cap tionedro rty.
Type of system: ElConventional a
ther s� S rga " pe Septic Tank: 1C3CXi gallons Pump Tank: gallons
Subsurface No. of exact length ,T width of ^z depth of
Drainage Field ditches of each ditch -��% feet ditches J feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date CSS
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