OPH T E # 13- 5 - -2>-:�55 -9 Harnett County Department of Public Health 23145
PERMIT # vC`2j 0 eration Permit
New Installation 8, S tic Tank Nit *fication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:o+vD og
Name: (owner) TL C� -ca2� Aar—E.5 SUBDIVISION C����� e� �J Ec�,sQtls LOT #X09
System Installer: -YoriES c. Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms �
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 C--)QD feet
System Type: :�1—e, 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 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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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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump El Alarm El Following are the specifications for the sewage disposal system on the above c ptioned erty.
Type of system: El Conventional Other Cw KMQ' t IL- �Q Septic Tank: t 0®
Subsurface No. of exact length width of
Drainage _..- .ditches ► of each ditch feet ditches 3
French Drain Required: _ _ Line' f4ttt_
Authorized State Agent ` \ '`'� _ �.�5 Date
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches I — inches
0.5—
1-6-5- 3