OPHTE# rq - 5 4101 Harnett County Department of Public Health 24681
PERMIT # �I+� 0 eration Permit .
New Installation eptic Tank ion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t0g3 5pvi v�CS/c-14z�
Name: (owner) `,0y nn C.oA5V cA�c v^ Trac SUBDIVISION A_,K-t P , ,i LOT #
System Installer: Tho. s A Registration # --,IBasement with plumbing: ElGarage umber of Bedrooms Lf-'
Type of Water Supply: ❑ Community folic ❑ Well Distance from well feet
System Type: ZS '4-ta.ae� o,'. 5. 5 - � 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 Ranh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all mnditiom of the Improvement Permit and [unstrumon Authorization.
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attacked 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 sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
Other 5x t= t vw �
Septic Tank 101, vo gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
J`� of each ditch t.o feet
ditches �_ feet
ditches 19 -74' inches
French Drain Required:
Linear feet
Authorized State AgentDate
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