OPHTE# 6th- r— Harnett County Department of Public Health 23342
PERMIT # Z,'188�— 0 ep ration Per it
Ltr] New Installation Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:c&j_7�Z�s /J
Name: (owner) _J,4 � .a 1Q SUBDIVISION 04 yr—s C�wssR -�r LOT # V_
System Installer: Registration #
Basement with plumbing: ❑ GA/rage ❑ Number of Bedrooms `/
Type of Water Supply: ❑ Community ❑ Public Well Distance from well i feet
System Type: Z 5'PC iZ&k T' G ,:—; Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must colilact 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:
V. Other:
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.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sew3ee disposal system on the above captioned property.
C—
Type of system:
El Conventional 1Z
Other 5i4A0z4z4iJ : ryia— Septic Tank: Leo
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch 2 °° feet ditches 3
feet ditches L ° inches
French Drain Required:
Lineeaar`teet
Authorized State Agent Lr i
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� s Date �' — 2 1— 1