OPHTE# t-4-5-41ao\ Harnett County Department of Public Health
24138
PERMIT # a 94 sqEr
eration Permi �
New Installation Septic Tank NiC'l/trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 350a7 (-s2 tssa)
Name: (owner) s enc l BkS<s — Z -,c-, SUBDIVISION ALOT #
System Installer: 5 Cw t\ c3 W\� =1, _ Registration #
Basement with plumbing: ❑ Garage Limber of Bedrooms ,
Type of Water Supply: ❑ Community G;-<ublic ❑ Well Distance from well feet
System Type: 5 ,r.'� Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system naz been installed in ampbana with applicable North Carolina General Statutes, Pules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. 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 -Boz ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewag�e �al system on the above captio�ned�roperty.
Type of system: ❑ Conventional Bother ice- V -to Septic Tank: t ocY>
Subsurface No. of exact length width of
Drainage Field ditches 3 of each ditchfeet ditches 3
H2OLine ❑ PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches 3 inches
trench Drain Required: Linear feet
Authorized State Agent ''�� Date I lao\i'5
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AqR"rTc.�2 2vv.n7 Ls,Z SS
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. 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 -Boz ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewag�e �al system on the above captio�ned�roperty.
Type of system: ❑ Conventional Bother ice- V -to Septic Tank: t ocY>
Subsurface No. of exact length width of
Drainage Field ditches 3 of each ditchfeet ditches 3
H2OLine ❑ PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches 3 inches
trench Drain Required: Linear feet
Authorized State Agent ''�� Date I lao\i'5