OPHTE# Harnett County Department of Public Health 23958
PERMIT # oZ8 /y2 eratl�n Permit
[alew Installation Se tic Tank �ification Line EJ Repair El Expansion
PROPERTY LOCATION: SOL /1.1/ IQId
Name: (owner) o rrv�i 5ern`c)et4 ( /�%� f� SUBDIVISION z LOT # y� Q
System Installer: lf:c k✓ 11-4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms oZ ('
Type of Water Supply: ❑ Community El Public VWell Distance from well /V,.) feet fro v-., eq
System Type: - Types V and VI Systems expire in S years.
9
(In accordance with Table V a) Owner --must Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement permit and lonswcnon Authorization
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring As required by Rule .1961.
111. 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 sewagAisposal system on the above captioned property.
Type of system: ❑ ler Other EZFlo ---� Septic Tank: /Ud U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditcho0 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent c C Date 3 2 2- Zc/G
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring As required by Rule .1961.
111. 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 sewagAisposal system on the above captioned property.
Type of system: ❑ ler Other EZFlo ---� Septic Tank: /Ud U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditcho0 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent c C Date 3 2 2- Zc/G
T.�, r
V , I ITA"
irk J��36