OPHTE# Harnett County Department of Public Health 24654
PERMIT # 2� 3 �f5 eration Per ' ��
New Installation Septic Tank LJ�Nrtrlfication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C 5!t l zoi i
Name: (owner) 'T: ((ani ru ul) SUBDIVISION LOT # -4A
System Installer: l t 5 rn� Registration #
Basement with plumbing. ❑ Garage ❑ Num er of Bedrooms 3
Type of Water Supply: ❑ Community L�ublic ❑ Well Distance from well feet
System Type: ZSio de jLy,6't n *0 — 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 imaned in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conmunion Authorization.
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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 ❑ %
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ 11201 -ins ❑ PWR Line
Following are the specifications for the sewa ' and syst on the above captioonned—RLOP rty.
Type of system: ❑ Conventional Other � �!>-fie Septic Tank: ZCx� gallons Pump Tank:gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch O feet ditches 3 feet ditches 1/ inches
French Drain Required: Linear feet
Authorized State Agent Date 0g I Z -4 t
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