OP RHTE# I C -s -3-'/)4" Harnett County Department of Public Health 24388
PERMIT # Zf /e Aeration Perm t�
LtiS New Installation G3`Septic Tank I1--l-Flitri6cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: G,%Vr; ,Z- 00AMA ✓Ld. 52 )slo4
Name: (owner) te-P tzn Sccs, 1, 1)6 SUBDIVISION LOT #
System Installer: c—aen Registration #
Basement with plumbing: Gel Garage Number of�Beddrr °ms
Type of Water Supply: ❑ Community El Public LN" Well Distance from well feet
System Type: C,or,.0-rt l, rine_A =11:c_ 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 Construction Authorication
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 -Box ❑ Pump ❑
Following are the sspedwlons for the sewage disposal system on the above captioned property.
Type of system: lam" Conventional ❑ Other
Subsurface No. of 0 Ce) exact length CD z
Drainage Field ditches Z� of each ditch 1Z0 I 1 feet
Alarm ❑
H2OLine ❑
PWR Line
0 (S) 0
Septic Tank: 1600 'IWO gallons Pump Tank 1000 gallons
width of depth of Q'
z
ditches _3 feet ditches Zy inches
French Drain Required: Linear feet
Authorized State Agent Date el3ilrI 1700
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