OPHTE# Harnett County Department of Public Health 24993
PERMIT # a 9S-4ci 09eration Permit
New Installation Septic Tank �litrf ation Line ❑ Repair ❑ Expansion
MktW&L-0B IC�1w 13w55 PROPERTY LO[ATION: 15G Maoae 9.,y4r-tet,. CL- m, as- s21806
Name: (owner) 2 �� � arms SUBDIVISION LOT #
System Installer. Genf s oc - 5ii 4Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms— 3
Type of Water Supply: ❑ Community ❑ Public 11? Iell Distance from well t 004- - feet
System Type: Q6 j k>s ry Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner m t 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
YtNnl l IONIVI I IUN):
1. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage sal system on the above a tion property.
Type of system: ❑ Conventional Other iY%T G\o.A Septic Tank: R Oa0 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches _Lt- //__hh of each ditch � feet ditches �S feet ditches !8 inches
French Drain Reauired: Linear feet
Authorized State hent Date 6-41104aO18
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