OPHTE#
_12-5-2553 Harnett County Department of Public Health
PERMIT # -22,33 . Operation Per It— 22485
IZ NeW Installation If Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t by z
Name: (owner) 1 /k1j 014" SUBDIVISION LOT # _
System Installer: &.r.r,; Azle4ll Registration #
Basement with plumbing: ❑ Garage I mber of Bedrooms 3
Type of Water Supply❑ Community IJ Public ❑ Well Distance from well feet
System Ty k 25 u 6 2d- k-1-- r �`''2�'�'a Types V and VI Systems expire in 5 years.
(In accordanc ,.Table a) ` Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nodh Carolina General Statutes, u'R`reT ar•iewes- Ixtatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
I&
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 ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other MA, a� •fa 2 5Y r2��. - i — Septic Tank: " " gallons Pump Tank: ` ` "3 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches -3 of each ditch feet ditches feet ditches P " i 9L inches
French Drain Reauired: Linear feet T
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Authorized State A"nt Date
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