OP RHTE# I G — � — 404+30 Harnett County Department of Public Health 24387
PERMIT # Z 3t/� NeAerati� on Permit
New Installation ErSeptic Tank Vitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: 211 Cx FckJ WcckA be o SL3y. !Vd .S? /00G)
Name: (owner) :5- (1v1ewr1C Prcwt--t-"eS SUBDIVISION K)'X�A . CkC -s LOT # 9
System Installer: G 1, n Registration #
Basement with plumbing: ❑ Garage ber of Bedrooms_
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well IC04 feet
System Type: 25 i, 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 Stamtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authomation
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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 ❑ N�
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 sewaoisposal system on the above captioned property.
Type of system:
❑ Conventional a
Other ZS iv uCl;nn 45'� rlo,.a
Septic Tank ILy) O gallons Pump Tank gallons
Subsurface
No. of
3
exact length
width of depth of
Drainage Field
ditches
of each ditch feet
ditches feet ditches Z-1, i✓`I inches
French Drain Required: Linear feet
Authorized State Agent ,lam e /lei Date 0'/1 06 +
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