OP RNTE# I l - 5 -40Obb(Z Harnett County Department of Public Health 24401
PERMIT # 2 �13y1 �l eration Permit
New Installation eptic Tank P-IIt iification Line ❑ Repair ❑ Expansion
SoSe F/Lhil rbo (o�;llrn Co1a< PROPERTY LOCATION: /56cAeI:tr C)nvrch tv. [S2L1550
Name: (owner) A` lui5h SUBDIVISION LOT #
System Installer: Sone ►S (e�sil:n Gtaf Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms '3
Type of Water Supply: ❑ Community Ca; ublic ❑ We-ll�t�T /—Distan�cefrom well feet
System Type: C-onyrnborsu\ C r \ 1+ TU- Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
nas teen msranea in compliance mm appocame nortn Lamina oeneru statutes, miles lot sewage Ireatment and Unposal, and all conditions of the Improvement Femme and Construction Authoriunon.
Jew (.I-lon�ca;�nar)
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PERMIT
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 -Box ❑ Pump ❑
Following are the spec Ions for the sewage disposal system on the above captioned property.
Type of system: 10 Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
French Drain Required: Linear feet
Alarm ❑
M20Line ❑
PWR Line
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 'Z 4e inches
Authorized State Agent Date a S I I Z / I ---