OPHTE# )1-��S-'i/25gg Harnett County Department of Public Health 24979
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PERMIT # 8t�roC Aeration Permit�
New Installation �
Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1) felrw,tsk Gk (Oa,S 06 S2 100
Name: (owner) Lc dmco L� SUBDIVISION C�n i 0A 14-t Rs LOT #
System Installer. Registration #
Basement with plumbing ❑ Garage GYNupkr of Bedrooms 13
Type of Water Supply:unity 1411QIic ❑ Well • -D-�ista--nce— from well "A feet
❑Comm
System Type: — y p _111Sa Types V and VI Systems expire in S years.
(In accordance with Table V a) Owne must contact Health Department 6 months prior to expiration for permit renewal.
This system has been imtalled 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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951—ASUNT LU 0(L. -'T
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
It. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other. _
Subsurface system operator required? Yes ❑ No [y
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑ Alarm
❑ M20Line ❑ PWR Line
Following are the specifications for
the sewage ' osal system on the captioned; property.
Type of system:
❑ Conventional
?her �f-
Septic Tank �� gallons Pump Tank: gallons
Subsurface
No. of
s j exact length
width of depth of
Drainage Field
ditches
"t of each ditch feet
�i
ditches J feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date OC, /C-'�(- / 2L
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V