OPHTE# tq-5-4 a315 Harnett County Department of Public Health 24157
PERMIT# fa h) owation Permit
Jew Installationeptic Tank cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: coos (—k . aA— (Set
Name: (owner) "Siont ►I c� Sc SUBDIVISION LOT #
System Installer. —r, \� Registration #
Basement with plumbing: ❑ Ga age ❑ Num f Bedrooms 4 it we,\k A�ra♦co�tL� Primo
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well r'A feet 4.�
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) I0 er must contact Health Department 6 months prior to expiration for permit renewal.
""' 'I'm" „v .,t„ ,,,„,n,,, ,u wnipnance mw appumore noon zzrmma Wnerai Itatutes rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I. Performance:
11. Monitoring
III. Maintenance:
IV. Operation:
V. Other.
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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 9-'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑ Alarm
❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage osal system on the above ca aoned property.
Type of system:
❑ Conventional 2'0ther
C—g r=t oS.
Septic Tank 1(3 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage field
ditches
of each ditch feet
ditches 3 feet ditches inch.,
French Drain
Required: Linear feet
Authorized
State Agent
Date o a a 11
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