OPHTE# Harnett County Department of Public Health 24977
PERMIT # a7 91:f8 gyration Per
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
n PROPERTY LOCATION: 154 —'-SSA i7ields Dc. ,a
Name: (owner) r%cxsiJ k Imo. ec\ `Jy , _S SUBDIVISION v LOT # 13
System Installer. -V-cant,, Registration #
Basement with plumbing: ❑ GarageN�u rof Bedrooms 3
Type of Water Supp1 : ❑ Community 13'Public ❑ Well Distance from well N'1 feet
System Type: Slac4z_ o4 SuS.�Types V and VI Systems expire in 5 years.
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(In accordance with Table V a) Owner 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.
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PERMIT CONDITIONS: ✓
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.Gt'�`
III. Maintenance: As required by Rule .1961. Other. s '
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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L; rte- 3 ., 96:rT
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage i sal system on the above captionerty.
Type of system: ❑ Conventional ther !�-z Septic Tank: kCX10 gallons Pump Tank: gallons
Subsurface No. of exact length �T width of depth of ^'�
Drainage Field ditches 1 of each ditch ;as feet ditches feet ditches �s Y inches
French Drain Required: Linear feet
Authorized State Agent Date '-'a 10 5 a�ol
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