OPHTE# � L+ -'5 liw' 0 Harnett County Department of Public Health 23383
PERMIT # 0 eration Permit
New Installation Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION: Q ea c s
Name: (owner) VA 2. \j c y0Q5 1N C- SUBDIVISION 0 LOT # )i Cb�
System Installer: Q +T, 5 S , cL\ L c, -,,p Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 5—
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 C)Q2 feet
System Type:? 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
1. 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 cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other Yt Z VI-6 W Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length _ width of depth of
Drainage Field -- ditches __L4 of each ditch S feet ditches feet ditches 1g-30 inches
French Drain Reauired: _ _ one
Authorized State Alzent_ )N`-, � J Date
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PERMIT CONDITIONS:
1. 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 cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other Yt Z VI-6 W Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length _ width of depth of
Drainage Field -- ditches __L4 of each ditch S feet ditches feet ditches 1g-30 inches
French Drain Reauired: _ _ one
Authorized State Alzent_ )N`-, � J Date
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