OPHTE# (I S OG (.I Harnett County Department of Public Health 24403
PERMIT # Z I3114 Permi�New
Installation Septic Tank E�i-litrification Line ❑ Repair Cl Expansion
PROPERTY LOCATION: 436 Cass tK oc. 6Usv1'L..:44 Ttt 11� Sfz IW
Name: (owner) C-Of"''„fy kAi,,%C;, i:lc.- SUBDIVISION Cross unr Mk"7 LOT #
System Installer: X% Registration #
Basement with plumbing: ❑ Garage �r of Bedrooms
Type of Water Supply: ❑ CommunityPLS ublic ❑ Well Distance from well feet
System Type:7i$ic- 2e�a�� { �„ :7T 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.
[his system has been installed in compliance with applicable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
3 PUMP to 25�„
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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 ElPump ❑ Alarm C3H20Line ElPWRLine
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: 11fonventional Ether �� laer �L b Septic Tank: /000 gallons Pump Tank: /0':J6 gallons
Subsurface No. of +, exact length width of depth of
Drainage Field ditches i of each ditch 80 feet ditches 3 feet ditches Z(- inches
French Drain Required: Linear feet
Authorized State Agent /0' Date L7�
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