OPHTE# I� 5 34q3. Harnett County Department of Public Health 24406
PERMIT # 21- N ZS pration Per '
N�
ew Installation Septic Tank Itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 2W M.11 6rcnL>n (,',r- [yo /&/ o,�)
Name: (owner) SUBDIVISION M 111 arc;nc,4 LOT # 3Z
System Installer. 1,_ses nn c,41 Registration #
Basement with plumbing: ❑ Garagelu of Bedrooms .3
Type of Water Supply: ❑Community 5 Public ❑- Wa— Distance from well feet
System Type: tk f -1 � -: o cs 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.
This system has been installed in compliance with appliable Noah Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all condirions of the Improvement Permit and Construction Authoriaation
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 ❑ 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 sewag�e vxsal system on the above captioned property.
Type of system: ❑ Conventional I�Other Z9 tLA )a ca �� F/c...J Septic Tank: sUUU gallons Pump Tank: gallons
Subsurface No. of LIL exact length _ width of depth of I
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: linear feet
Authorized State Agent � ���� ' z Date C1 �/
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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 ❑ 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 sewag�e vxsal system on the above captioned property.
Type of system: ❑ Conventional I�Other Z9 tLA )a ca �� F/c...J Septic Tank: sUUU gallons Pump Tank: gallons
Subsurface No. of LIL exact length _ width of depth of I
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: linear feet
Authorized State Agent � ���� ' z Date C1 �/
2
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