OP RHTE# t� s 2 Harnett County Department of Public Health 24838
PERMIT # a v56 0 eration Permit
[Y, ew Installation C� Tank p?'Art fication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Soy rz- (toL atm )
Name: (owner) l� aoS,r�s�� tlar.�s SUBDIVISION nor ns� s f� LOT # 3�
System Installer: ��' �✓— Registration #
Basement with plumbing: ❑ Garage f her of Bedrooms i4
Type of Water Supply: ❑ Community 0, �Dlic ElWell Distance from well " feet
System Type: a4� Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ner 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
PERMIT CONDITIONS
I. 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 ❑ 112O1-ine ❑ PWR Line
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�y
Type of system:
El Conventional Other
(Z&/—> Cif 1� �
Septic Tank: t a gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches I
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ditches _3 feet ditches inches
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PERMIT CONDITIONS
I. 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 ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sewage osal system on the above captioned �ro�erty.
�y
Type of system:
El Conventional Other
(Z&/—> Cif 1� �
Septic Tank: t a gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches I
of each ditch feet
ditches _3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent 4�� Date
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