OPHTE# '41; 96S Harnett County Department of Public Health
24150
PERMIT # a, ��� a ration Perm'
L3 New Installation Septic Tank 0-Nitntiication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ioc) or, nw Le Ln (LgJG tLC ✓ nA Set 1-9 44
Name: (owner) 5rnsnn k Arntaws los] SUBDIVISION LOT #
System Installer. L'c En SL.a r Registration #
Basement with plumbing: ❑ Garage ❑ Nu f Bedrooms 3
Type of Water Supply: ❑ Community 2 Public ❑ Well Distance from well feet
System Type: CiC r1J01 c.A \ 5 -as .-n i3 f Types V and VI Systems expire in S years.
(In accordance with Table V a) VOwner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applimble North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and concoction Authorization.
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PERMIT CONDITIONS: 2 S3ly
Performance: System shall perform in accordance with Rule .1961
Monitoring. As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 2'
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 disposal system on the above caption roperty.
Type of system: f�tional ❑ Other i,fy- GWP Septic Tank: i WU gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch_ feet ditches J feet ditches ay-�Aa_ inches
French Drain Required: Linear feet
Authorized State Agent CT/i»mo i —Ay— Date of t3 1 autg
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