OPHTE# X,�B Harnett County Department of Public Health 24165
PERMIT # a 6 Owation Permit -
4 -.Kew Installation Erl—eptic Tank ation Line ❑ Repair ❑ Expansion
m0.k- (;n - ACA 6m obc PROPERTY LOCATION:3oAO K ell;� a .,c\ (�2 1U4'i
Name: (owner) S �r ov \ o��-�c3m�5 SUBDIVISION r—c LOT # 44
System Installer: Registration #
Basement with plumbing: ❑ Garage I�er f lediFooms S
Type of Water Supply: ❑ Community E;-Ifu61ic ❑ Well Distance from well r" feet
System Type: a Types V and VI Systems expire in S years.
(In accordance with Table V a) Ow st contact Health Department 6 months prior to expiration for permit renewal.
]his system has been installed in rompliano with applicable North Carolina General Smtutes. Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the
specifications for
the sewage al system on the above captioned property.
Type of system:
❑ Conventional
Other %a
Septic Tank: f aSb gallons Pump Tank:
Subsurface
No. of
exact length
3
width of depth of •�
Drainage field
ditches
of each ditch l S feet
ditches 3 feet ditches oc y
French Drain Required: Linear feet
Authorized State Agent Date 'v 3 aCa ;;j 01
PWR Line
gallons
inches
J
MAR