OPHTE# (- s - 411sb Harnett County Department of Public Health 24146
PERMIT # q 39 a nnprntinn Parmit
Jew Installation eptic TankItB�fl' rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 344 A.als.f. CIn l I.r k 0.6 52tgA
Name: (owner) t0Anc,, C orLCr ct<on s SUBDIVISION _ ���y P r c` —W LOT # !�_e@
System Installer: or e, A &"bif�5 Registration #
Basement with plumbing: ❑ Garage,, _umber of Bedrooms _K_
Type of Water Supply: ❑ Community 111�P blu ❑ Well Distance from well feet
System Type: Asb 2c.a i `t 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.
Ibis 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.
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
❑
H2OLine ❑ PWR Line
Following are the specifications for the seewwage d system on the above captioned progeny.
Type ❑
of system:
Conventional Ott her �lc� �\
Septic Tank
S ;?S6 gallons Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditches of each ditch % 5 feet
ditches
S feet ditches PL inrhea
French Drain Required: Linear feet
Authorized State Agent ! �� Date -'a/ C,1 I vicxl�
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