OPHTE# aHarnett County Department of Public Health 24152
PERMIT # 9.3 -7- eration Permi��.
New Installation Septic Tank grl-it tllca/tion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ib AAAI:Min C-1 (Bcic.0 N fi 2.1, SrZ ac65i
Name: (owner) lam.'. ,jw47 FFcxytGs SUBDIVISION LOT # aL
System Installer. T1n c pt > Registration #
Basement with plumbing: ElGarage arab droams
Type of Water Supply: ❑ Communityublic ❑ Well Distance from well f - feet
System Type: - Types V and VI Systems expire in 5 years.
(In accordance with Table V a) I Ow�ner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Pemdt 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 ❑
Following are the specifications for the sewage disposal system on the above ca tione roperty.
9
Authorized State At?ent
H2OLine 11
PWR Line
Type of system: El Conventional
cher 4- fr'Fc,� ea
Septic Tank I CiDO gallons
Pump Tank: gallons
Subsurface No. of
exact length
wi dth of
depth of
Drainage Field ditches 3
o each ditch feet
tches feet
di_�
ditches � inches
French Drain Re aired:
Linear feet
Date
Kms` l�n iay i�
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At
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