OPH T E # I s -41215 Harnett County Department of Public Health 24712
PERMIT # 2 -`a4$ -'Of Oueration Permit
[a'-N—ew Installation Otic Tank mon Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 6o craw. A Gr,,KIeC o . (36 10 z 54- 0
Name: (owner) SUBDIVISION LOT #
System Installer: H �S,v., wtUic,,rns Registration # IItCS_,
Basement with plumbingbing 11 Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community E?- uf' blit ❑ Well Distance from well 1�q feet
System Type: 2-65c c Sts ;Z — Types V and Yl Systems expire in 5 year.
(In accordance with Table V a) Ownecontact Health Department 6 months prior to expiration for permit renewal.
This system has been instilled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
V/
D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PAIR Line
Following are the
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
�LV w
Septic Tank: gallons
Pump Tank gallons
Subsurface
�5 L3j
exact length
width of
depth of
Drainage field
I
3 of each ditch ;-5 feet
ditches �_ feet
I IN
French Drain Required:
Linear feet
91 �
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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
❑ PAIR Line
Following are the
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
er T ;-- CC -
Septic Tank: gallons
Pump Tank gallons
Subsurface
No. of
exact length
width of
depth of
Drainage field
ditches
3 of each ditch ;-5 feet
ditches �_ feet
ditches inches
French Drain Required:
Linear feet
Authorized State Agent Date 1 11 I 2 c /'ao R --:L—
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