OPHTE# ► - 5 Harnett County Department of Public Health 24689
PERMIT # Z q �1G0 Qwation Permit,
C'New Installation g Septic Tank kation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: $ y A4k,A 5 itA- 5,,c ifliil�
Name: (owner) fkAe,t, u-6, 4&,\. LrA. SUBDIVISION }k,/Its d&-.Zj _ LOT # W
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms ,3
Type of Water Supply: ❑ Community 13-11sahlic ❑ Well Distance from well feet
System Type: Z6%v f"a c Tuk-m—as - 7j27- Types V and A 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 Impmeement 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 ❑ 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
Type of system: ❑ Conventional
the sewage disposal system on the above captioned property.
LYOther og 'T -T1, Septic Tank: I ou a
gallons Pump Tank: gallons
Subsurface
No. of
exact length �iq, r3;te width of
depth of
Drainage Field
ditches
of each ditch at G feet ditches_
feet ditches rF inches
French Drain Required: Linear feet
Authorized State Agent Date tff / I S 0T —
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