OPHTE# I - 5 - Ya I C, Harnett County Department of Public Health 24850
PERMIT # 1 Qcation Permit
New Installation[] -Septic Tank kation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Fr:e.�ZSG ;. �� Cott 2-i. 5. sA ate,
Name: (owner) Ghe lcs +a. roti x S SUBDIVISION LOT #
System Installer. 6o6b z do s Registration #
Basement with plumbing: ❑ Garage ❑ �Nu er of Bedrooms 3
Type of Water Supply: ❑ Community GYPublic ❑ Well Distance�fr m well —a- feet
System Type: a5i 2cl.�c c ' n s 2 Types V and yI Systems expire in S years.
(In accordance with Table V a) Z0 ner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in mmpliana with applicable North Carolina General Stamm, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Amhorizanon.
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PERMIT CONDITIONS
I. Performance:
11. 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 ❑
H2O1-ine ❑
Following are the specifications for the sewageoposal system on the above captio_ned property.
Type of system: 11Conventional I�Other E 2 Q'I w Zl. Septic Tank: I OcY-') gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 90 feet ditches 3 feet ditches a a
French Drain Required: Linear feet
Date SS 1 aCSI
Authorized State Agent C ��.-�J11-/'/sem--����—��L� to I
PWR Line
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