OPHTE# 1. -5-3 134, Harnett County Department of Public Health
PERMIT # 0 ep ration Permit 22824
New Installation X Septic Tank ) ` Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M -c C)o -u (�� zp P,,p
Name: (owner) Q tam V— oIO-Q– SUBDIVISION LO'
System Installer: 5 ovji . Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1 i._o, 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.
finis system has peen installed in
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With appllCaole north larollna beneral )tatutes, Wes for )ewage treatment and Ulsposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other '10 ° -J
Subsurface No. of exact length
Drainage Field ditehe LA of each ditch �-' ® feet
French Drain Required: ��._ �ltnear feet
Alarm ❑
142O1-ine ❑
Septic Tank: 1000 gallons Pump Tank:
width of 2 depth of
ditches feet ditches
Authorized State Agent ���. ����' Zc- y' Date (;: )j 113
PWR Line
gallons
inches