OPHTE# l(?, -s-430 9 Harnett County Department of Public Health 24975
PERMIT # a `1855 eration Perm'
New Installation Septic Tank 2 Nltrdlcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -19 2 rx L t- G a I o
Name: (owner) Q6 ,; Crime V e' c�� SUBDIVISION LOT #
System Installer: NA( crL n!!� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public Ir7k'fell Distance from well 101 feet
System Type: Cl4&.�-�c�Cl Types V and VI Systems expire in S years.
(In accordance with Table V a) Own must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in mmpliana with applicable Noah Carolina General Statutes, Rules for Sewage Treatment and Dispmal, and all conditions of the Improvement Permit and Construction Authonation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.'-'�HI1=T£s� 'r -o T: l VE{6i
II. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage ddii sal system on the above captioned ro erty.
Type of system: ❑ Conventional LVOther f_; _tc� Septic Tank gallons Pump Tank: gallons
Subsurface No. ofenCoact length �/�� width of depth of
Drainage Field ditches of each ditch � feet ditches feet ditches 2a inches
French Drain Required: Linear feet
Authorized State Agent _ �" Date 0513c>I Rc,,
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