OPHTE# 13- 5-3as64 Harnett County Department of Public Health
PERMIT # YK ' Operation Per It 22987
Ea New Installation Septic Tank CeNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:,�kluo37' sr C
Name: (owner) /3 /ZC <f-, T;,-c SUBDIVISION Qv&r -( 09A LOT # v;
System Installer: Asa, y-_A*f_, Registration #
Basement with plumbing: ❑ Garage Z Number of Bedrooms If
Type of Water Supply: ❑ Community CSI' Public ❑ Well Distance from well feet
System Type: 29.6 Rotes 47j-)., sz54-a 2, rte. n1' G �� Types V and VI Systems expire in 5 years.
(in accordance with Table V a) 6 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:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
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: El enti
Convonal Other ¢b S4 Septic Tank: 17,0 y gallons Pump Tank: gallons
Subsurface No. of exact len th width of depth of
Drainage Field ditches 2' of each ditch f `sc' feet ditches 3 feet ditches .Zy inches
French Drain Required: Linear feet
Authorized State
Date ! 0 (I - t 'S
13 -5 -30504 (1) 13 -5 -30504 (2) 13 -5 -30504 (3) 13 -5 -30504 (4) 13 -5 -30504 (5)
13 -5 -30504 (6) 13 -5 -30504 (7)