OPHTE# II -5-4"19y Harnett County Department of Public Health 24137
PERMIT# ay45a 0 ation Permi
New Installation Septic Tank tion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 39oa LSrt
Name: (owner) 5t<. o;l qt A, SUBDIVISION LOT # ✓
System Installer: 5 a la s ter. c • Registration #
Basement with plumbing: ❑ Garage f f Bedrooms 3
Type of Water Supply: ❑ Community Ek'Public ❑ Well Distance from well feet
System Type: Q S%r. 't.— I _'_k o ti S_s" ]✓ Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal
This system has been installed in mmpliana with applicable North Carolina General statutes, Rules for sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
as 2zF-s75 .
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I. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring:
As required by Rule .1961.
111. 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
❑ M20Line
❑ PWR Line
Following are the specifications for the sewage disposal system on the above coca t roperty.
Type of system: ❑
Conventional ❑�er �� �� ,,i1 �
Septic Tank: I c-a&y gallons
Pump Tank gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditches 3 of each ditch feet
ditches �V feet
ditches �� inches
French Drain Required: Linear feet
Authorized State Agent �L�t� Date x�l Itfe Ia�L
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