OP RHTE# tG - 5-3po"t Harnett County Department of Public Health 24672
PERMIT # ZG3a� - eration Per
New Installation Septic Tank 5?I�itr'dication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: tig 44e, P o ,f I.r.c Cd 52 /e/zJ
Name: (owner) Otir\:\ C01)56rja�ok -stir' SUBDIVISION A.,«. c LOT #
System Installer. :13n,% C—kr"',s '< 121.mlbsnD Registration #
Basement with plumbing: ❑ Garage [; umber of Bedrooms —��
Type of Water Supply: ❑ Community � ❑ Well Distance from well feet
System Type: 2-Sio to C l a l Ste. ::I=k 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 Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes o ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑
Pump ❑ Alarm ❑
112O1-ine ❑ PWR Line
Following are the specifications for the sewage '
posal system on the above captioned property.
Type of system:
❑ Conventional Other
i9a: F/o.a -22Z:W Septic Tank:
/000 gallons Pump Tank /c)Oc4 gallons
Subsurface
No. of
exact length 850) fco� width of
depth of
Drainage Field
ditches 3
of each ditch W, feet ditches
.3 feet ditches lb inches
French Drain Required: linear feet
Authorized State Agent �r ��"- iA05;; S Date O 7/ I R Me) I �
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