OPHTE# I 40G 3 Harnett County Department of Public Health 24627
PERMIT # Z53Z4 eration Permit
New Installation eptic TankN8' itrirication Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: 09V Crag L ik Dr LGt-+4ty�
Name: (owner) 6nm�c)rt 140mo3 , Sre. SUBDIVISION c. r c66 I-:, i P!� c� a LOT # if
System Installer: (Lk>SSeI ( PV, 1I 1 Registration # 3905
Basement with plumbing: ❑ Garageu ber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Zjryu A, A,)C,b- nn 5;2$ . —J L1 -1 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 Norah Carolina General Suitutex Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
PERMIT CONDITIONS
I. Performance:
II. 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 ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sewage
osal system on the above captioned property.
Type of system:
❑ Conventional FJS' Other
ZSio ftcat Aicn) GW.wlrr Septic Tank: I W
gallons Pump Tank IWC gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches ��
of each ditch CJ feet ditches 3
'' yy
feet ditches � inches
French Drain Required:
Linear feet
Authorized State Agent� rr�; i Date OellUlzol�tc—
r�
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