OP RHTE# 1 g -5 - vls2 Harnett County Department of Public Health 24658
PERMIT # Z5 ib5 ration Permit.---
ermi - .;
New Installation Septic Tank Erlitriffication line ❑ Repair ❑ Expansion
PROPERTY LOCATION: IM C„rr, Lgeff 6,r. (6S 4, le, taasrireitct,4A_ Srcts�
Name: (owner) Grp blti�n (1 n56. Gn. SUBDIVISION cswilly, t_,rouPr LOT # fy
System Installer: _ Czj d on QA - 9C'wc, Registration # f11/5
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 F feet
System Type: z3AV ai 1 CL.."A $25, � 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 North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 seewwage l system on the above Property.
Type of system:
❑ Conventional
_captionedt
OL�I' they cln' +n(a.er �..La.-..
Septic Tank: 1cX.X3 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
a of each ditch L&O feet
ditches _ feet
ditches 7A 4 W inches
French Drain Required: Linear feet
Authorized State Agent Date LU3 / 7-61 —4-
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