OPHTE# I q -5-t-41 aA Harnett County Department of Public Health 24679
PERMIT # Z cjf 3'4 ( 0 ation Permit
2 -few Installationeptic Tankit��rirication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ 258 Avef Pc„a p r� ". 6e. de ¢,t 0142k�i
Name: (owner) CJti e%n C e r t r c l- re(. -.V--e-)c SUBDIVISION yLOT # C6
System Installer. —v In c,r-S P 1ss? n4 , r Registration # L/
Basement with plumbing: ❑ Garage 9-11nm-ber of Bedrooms
Type of Water Supply: ❑ Community C3—Po6ilc ❑ Well Distance from well "-'4 feet
System Type: 'LS `i /l c_d�A S 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.
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 Comauction Authorisation.
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PERMIT CONDITIONS.
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
Other.
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: 13 Conventional f�her r—;;- P, U-:1 —137-1ra Septic Tank I2 Sc, gallons Pump Tank 1036 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches 3 feet ditches a41 inches
trench Drain Required: Linear feet
Authorized State Agent �����_ �'��/J� Date /O/ o5 /avl-4
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