OPHTE# Te- 5- q s3af Harnett County Department of Public Health 24944
PERMIT # a`S�?) Oneation Permit
��lew Installation Eg-'Se-p—tic Tankation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:—8@0 M bre 2a. (srt i536)
Name: (owner) '2ober(-- ,wfegc a SUBDIVISION LOT #
System Installer: NiRegistration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ElPublic ell e -from well y CX:, f feet
System Type: ia5cie, Geo [ 'o Sa 5 . d! - Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
AP E./ --T a?"i,
This system has been installed in compliance with applicable North Carolina General Sciences, Rules for Sewage Tnacmjnt and Disposal, and all conditions of the Improvement Permit and Construction Authorisation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage di gal system on the above captioned roperry.
Type of system: ❑ Conventional L�YOther G3 t�t� v Lx3 -'a Septic Tank: s dei eallons Pump Tank: eallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 50 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent i Date 011 CAI aC.)18
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