OPHTE# (�-5-q3$1 Harnett County Department of Public Health 24997
PERMIT # 9g9a aeration Permit..
New Installation eptic Tank 2 Httrlftcation Line ❑Repair LEI Ex ansion
PROPERTY LOCATION: ola S1s„� nA . (Sn IUU�
Name: (owner) 27—y—, SUBDIVISION 0 x LOT #
System Installer: R-05:km QY,s ,85 Registration #
Basement with plumbing: ❑ Garage un -of Bedrooms 3
Type of Water Supply: ❑ community blic ❑ Well Distance from well N� feet
System Type: 65, (Le- s , Types V and VI Systems expire in S years.
(In accordance with Table V a) Ownerinest 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
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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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa ' posal system on the above captioned pro erty.
Type of system: ❑ Conventional Other _QLI Ghc0.66's— Septic Tank: 101 x gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of _
Drainage Field ditches 3 of each ditch 4S feet ditches feet ditches av inches
French Drain Required: Linear feet
Authorized State Agent 4W Date a� ��
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