OPNTE# a9- r Harnett County Department of Public Health 21283
PERMIT # keration Permit
New Installation Septic Tank ❑ Repair erNitrification Line ❑ Expansion
PROPERTY LOCATION: ~Gdc S~~
Name: (owner)s, r c ~Sd~~, Af,r~ SUBDIVISION L rf~/~ 7"rce.w LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 1?_
Type of Water Supply: El Community ❑ Public Well Distance from well 00'~ feet
System Type: 77E7 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 (alolina General Statutes,
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and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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:
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Following are the specifications for the sews disposalsystem on the above captioned property.
Type of system: ❑ Conventional (Other )t ? Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of 7 depth of i- z z t- `r
Drainage Field ditches of each ditch /00 feet ditches ✓ feet ditches4,'--`-3 '16 inches
French Drain Required: Linear feet
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Authorized State Age _ Date 5 Ti-7,zc,/ o
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