OPHTE# All —Sr- 335SI— Harnett County Department of Public Health 23330
PERMIT # ? $BIZ Operation Per it
2 New Installation Eo Septic Tank 2' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PgyB rtflet a3 AoD
Name: (owner) _ lfm A:: � 141n, a+ , :941C- SUBDIVISION S LOT # 36'
System Installer: P&I -sri -1 Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 03
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: 5% r k,-• i es V and VI Systems expire in 5 years.
(In accordance with Table V a) rOwner must contact 10alth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carl ina General Statutes, Rules for Sewa atment and Disposal, 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.
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:
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❑ 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 Other Z5°6'ZftvLXIX, . S-,5 Septic Tank: t boo gallons Pump Tank: gallons
Subsurface No. of U exact length width of depth of
Drainage Field ditches f of each ditch o 0 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State A e+�t'"�� -� ___ " l 'p� Date °7— :5 —
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14 -5 -33556 (17)
14 -5 -33556 (1)