OPHTE# tz -' - 3621 o Harnett County Department of Public Health
PERMIT # L-1 2 3/ Operation Per it 22985
I%J New Installation 2f Septic Tank Q Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /y3-7 13--2�-. ✓W
Name: (owner) 1344fe-. SUBDIVISION 7- LOT # Z�
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: LVA : -j-s46 --.- Tub- � 6- /9 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 Carolin General Statutes Rules / Sewage Treatment aid Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Kule AM.
II. 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 ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑
Conventional LJ Other
15°18 KkJ�,, u_ 5. <s L--v-•--
Septic Tank: 1 a a e gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches _ 5
of each ditch a 0 feet
ditches �_ feet ditches Z� >t inches
French Drain Reauired:
Linear feet
Authorized State A ent ,- �- Z_ %Ul a Date 10— l "t 1 3
12 -5 -30210 (1)
12 -5 -30210 (2)
12 -5 -30210 (3)
12 -5 -30210 (4)
12 -5 -30210 (5)
12 -5 -30210 (6)
12 -5 -30210 (7)
12 -5 -30210 (8)
12 -5 -30210 (9)
12 -5 -30210 (10)