OP RHTE# 15-5 — 3G$t32 Harnett County Department of Public Health 24148
PERMIT # enation PPernin
New InstallationL9 'Septic TankNip' trification line ❑ Repair ❑ Expansion
RAW
PROPERTY LOCATION: Pc rte Gat- Ln. MgrfeS A • Sct 1111
Name: (owner) {'CA`l�1cA S-. (&zr s— SUBDIVISION SW Ia-Zrnr C=—,s6A 2_ LOT # I Ia-4 1703
System Installer: LcAr- �A !6\n6Lr,Re_ Registration #
Basement with plumbing: ❑ Garage �❑ Numb of Bedrooms
Type of Water Supply: ❑ Community LYPublic ❑ Well Distance from well feet
System Type: C -Ora vela% Ona\ S c5 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 campliana with apbliable North Carolina General statutes. Rules for
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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:
conditions of the
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Permit and construction Authorization.
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specificati the sewage disposal system on the above captioned property.
Type of system: onventional ❑ Other a ii f P CAS rn Septic Tank: t 000 gallons Pump Tank: gallons
Subsurface No. of I exact length width of depth of
Drainage Field ditches a of each ditch 1,00 feet ditches 3 feet ditches I inches
french Brain Required: Linear feet
Authorized State Agent C7 ,a 2��� Date OR / 09 i a p143
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