OPHTE# 09' 500- aa022 Harnett County Department of Public Health 2 0 9 7 5
PERMIT # 254- 'Installation Per t
VNew Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: D_ L P "1-W p L -P,,
Name: (owner) ' UnA t & 0-, ~ SUBDIVISION dn4i n LOT
System Installer: Nou, Registration #
Basement with plumbing: ❑ Garage 'V Number of Bedrooms
Type of Water Supply: ❑ Community' Public El Well Distance from well ~'1 J feet K 1
System Type: A -c Lt Types V and VI Systems expire in 5 years.
(In accordance with TT Ieab 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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1. 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-4K
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional V` Other k Septic Tank: 1110 0 0 gallons Pump Tank: gallons
Subsurface No. of xact length width of depth of
Drainage Field ditches ' of each ditch- feet ditches feet ditches Q a inches
French Drain Required: Linear feet
Authorized State Agent ~-5 Date i_~)I - 01
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