OPNTE# —S-u3�o Harnett County Department of Public Health 24991
PERMIT # 3�' eration Perm' �
ff New Installation Septic Tank C" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: S annv6,Mcbots tLA, S2 flIr,
Name: (owner) I;U SUBDIVISION C1 u1�r n rnon �- LOT #
System Installer: `tW A ; Registration #
Basement with plumbing ❑ Garageumobr of Bedrooms S
Type of Water Supply: ❑ Community & 1 blic ❑ Well Distance from well e- N feet
System Type: Types V and VI Systems expire in S 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 LomWmon wtnon:auon.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961. /
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for
the sewa spas al system on the above_%ptimed_property.
a5�
Type of system:
❑ Conventional
Other�S4�ett �i Ea
Septic Tank: gallons Pump Tank: gallons
Subsurface
No. of
exact length
a
width odepth of
f fG
{- inches
Drainage Field
ditches
of each ditch �a feet
ditches feet ditches
French Drain Required:
Linear feet
Authorized State Agent �
/��A Date
C
V
0
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Q
C
V