OPHTE # IS" 5-Ib5 % Harnett County Department of Public Health 23657
PERMIT # 0 enation Permit
I New Installation X Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION: �.���
Name: (owner) Lti o -A Q�L-0EX6 Irs t. SUBDIVISION LO'
System Installer: 7r 2 ix`Y IM Ekj'U-3Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community A Public ❑ Well Distance from well i ®0 feet
System Type: 5 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.
anis system nos peen instauea in compnance wan appocaoie nortn Lamina eenerai statutes, ewes for sewage treatment ana uisposao, ana au conamons of the improvement rermtt ana construction nutnorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above c ptioned perry.
Type of system: El Conventional Other C-1AS .'M "��Septic Tank: `®®� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field --fi� of each ditch Sly. feet ditches feet ditches lir; QM inches
French Drain Require . Linear feet
Authorized State Agent,?lam-� 5 Date i)5—
r5-5- -35� lig",