OPHTE# 11-6-4a12 1 Harnett County Department of Public Health 24959
PERMIT # a —I DDeration Perm'
New Installation Septic Tank Edification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: `gal Mott4i1 Ln. T' Yc- ,%4 U. S2 t5
Name: (owner) (Gc�c. —A &e)hveLc x, U\-rni SUBDIVISION LOT #
System Installer. U \\cRegistration #
Basement with plumbing: ❑ Garage Number of�Bedr000 3
Type of Water Supply: ❑ Community ❑ Public Ld�Well Distance from well ((a Net
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Own ust 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. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
614
l
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
A (6 L—Mw—
L.Ae 3.
❑
D -Box ❑
Pump ❑ Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for the sewage sal system on the above captioned_ promo eW
Type of system:
11 Conventional L�YOther
aq Ct e ref �xs Septic Tank IQS)b gallons
Pump Tank gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches 3
p
of each ditch feet ditches 3 feet
ditches t inches
French Drain Required: Linear Net
Authorized State Agent ��_/ _ate Date sia IOGiJe?It E
- 7" .k iA, I I /
191