OPFITE# U1-s= -113y Harnett County Department of Public Health 2 0 6 9 4
PERMIT # ash 17 9peration Perm
New Installation E' Se tic Tank ❑ Repair El Nitrification Line ❑ Expansion
PROPERTY LOCATION: 5?y !,-.r e~-
Name: (owner) ~horto.s ~ib,P SUBDIVISION Sc.,«~e,r L) S{~,,,t; ! LOT #
System Installer. a++:_r1J_~-; c k 1G.,d Registration #
Basement with plumbing: ❑ Garage VNumber of Bedrooms
Type of Water Supply: ❑ Community Q"Public ❑ Well Distance from well /00 feet
System Type: = ,4 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact 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 Construction Authorization.
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PERMIT CONDITIONS: f~a,
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No lir
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the ssppee ' ations for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of 3 exact length
Drainage Field ditches of each ditch feet
Septic Tank: ION gallons Pump Tank: gallons
width of depth of ( I
ditches '3 feet ditches 7 inches
French Drain Required: linear feet
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Authorized State Agen Date 2~ 'If
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