OPHTE# «-5- c/Olsg Harnett County Department of Public Health 24415
PERMIT# beration Permit
New Installation Septic Tank B Ntiniication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: m.n, \ Star. us Ln CCnSt-bc (c cacti SR klefi
Name: (owner) `,Janet f iALr'r.1;tsA T7rl SUBDIVISION A,t«ti Pun — LOT #
System Installer: � Plvrn Registration #
Basement with plumbing: ❑ Garage umber of Bell ooms 4L
Type of Water Supply: ❑ Community 9-lublic ❑ Vyell Distance from well feet
System Type: 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 applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constnmtion Authorization
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PERMIT CONDITIONS -
1. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage osal system on the above captioned property.
Type of system: ❑ Conventional Lei' Other e�K—oz GLo Septic Tank
Subsurface No. of exact length width of
Drainage Field ditches y'" of each ditch too feet ditches _
H2OLine ❑
PWR Line
Z S o gallons Pump Tanic I Z.3 o gallons
depth of
3 feet ditches 30-t' 1$ inches
French Drain Required: Linear feet
Authorized State Agent .�/6��/�f_'// Date �7L Z4lto�
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