OP RHTE# 6 4—S -Z0g332 Harnett County Department of Public Health 24394
PERMIT # Z9 Z10 motion Permit
P'New Installation G --Septic Tank F-4-11-hriftcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: j dyiAiikvs ir� tZdA. /'52 yssi)
Name: (owner) 6606 l 6u; ldecS nc. SUBDIVISION LOT # 3
System Installer. rL mo 641)0- Registration #
Basement with plumbing: ❑ Garage TAwnW of Bedrooms
Type of Water Supply: ❑ Community 179Y Public ❑ Well Distance from well feet
System Type: moi— 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.
this system has been installed in compliance volts applicable north Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Awlsomation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
111. 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 seewwage�sal system on the above captioned property.
Type of system:
❑ Conventional LFYOther
Z5jo Septic Tank: '000
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage field
ditches 3
of each ditch 90 feet ditches 3
feet ditches Z6 inches
French Drain Required: Linear feet
Authorized State Agent l Date O s 0 5/ Z c (�--
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