OPHTE# 1$'S-�a34'+ Harnett County Department of Public Health 25079
PERMIT # o�t`1Operation �Pyermit
New Installation 1L Septic Tank, Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3`11 ' Hoo`/ 6woo'e.Lr
Name: (owner) \4oGLUS— VA -41— LtaUee�,r SUBDIVISION LOT # c7.
System Installer: C' Mt.Umbl .J Co Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms �_ _N
Type of Water Supply: ❑ Communit ❑ Public X Well Distance from well t 0O feet
System Type: - X11_ Types V and VI Systems expire in 5 years.
(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
I sj T
w ust
0
Q
i
O E
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
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 disposal system on the abyvecaptio property.
Type of system: ❑ Conventional Other Ct A' -tom 1a' Septic Tank tom' gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field �'I of each ditch 90 feet ditches 3 feet ditches PLO inches
French Drain Required: Linear feet
Authorized State A¢ent Date
IL-5-li33`)1