OP RHTE# I'1-S--4q>l'/ 2 Harnett County Department of Public Health 24848
PERMIT # 21'fyl Ouration Permit
Jew Installation 17 Septic lankItrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_C43 2s A — CL.'dw__ Pc-, (6c i
Name: (owner) SUBDIVISION Rl.xr ¢:� LOT # 5b3
System Installer: 7s— Registration # 9493
Basement with plumbing: ❑ Garage Cillumber of Bedrooms 3
Type of Water Supply: ❑ Community ❑ Public C�Well Distance from well -`z>o'F feet
System Type: 9 c5y t4 \'t—y'F n 5�7o T Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner most 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
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ PWR Line
Following are the specifications for the sewage dhis oral system on the above captioned roperty.
Type of system: El Conventional Lel--Other E ir= 4:a Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length T width of depth of
Drainage Field ditches T of each ditch /UU feet ditches 3 feet ditches_ inches
French Drain Required: linear feet
Authorized State Aeent Date
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