OP RHTE# 1-1- 5-y a 3352 Harnett County Department of Public Health 24832
PERMIT # 2X39 0 Qration Permit --
ew Installation Septic Tank Itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_S?g msittr 2A ( 52 t�o61
Name: (owner) Mor -w— SUBDIVISION LOT #
System Installer: r3utA21 r� �s Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public 0-�e I Distance from well 200 feet
System Type: - vAcAvc n _ Types V and VI Systems expire in 5 years.
(In accordance with Table V a) - wner 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 Imprueement Permit and Construction Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑
1-12O1-ine ❑ PWR Line
Following are the
specifications for the sewage disposal
system on the above captioned roperty.
Type of system:
❑ Conventional 0-:� rther
>✓ /%a/c- 7 s Septic Tank:
/GUv gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch feet ditches
3 feet ditches inches
french Dram Required: linear feet
Authorized State Agent ` �� ��iGLS Date
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