OPHTE # /4i-s -3330(, Harnett County Department of Public Health 23359
PERMIT # o� ?ASS � eration Pe It /Nitrification New Installation Septic Tank Line ❑ Repair ❑ Expansion
PROPERTY LOCATION;v-?_/ Yg_3 P?i�,rob
Name: (owner)Z � 1, Z, SUBDIVISION 1/. !,� LOT # L/
System Installer: ANUS s - Registration #
Basement with plumbing: ❑ Garage —/Number of Bedrooms -5
Type of Water Supply: El Community L� Public ❑ Well Distance from well feet
System Type: ZS%LZft1 Tirz-V a h ypes 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 Carklina 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: 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: ! oo 8 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 4 of each ditch feet ditches � feet ditches 28-519 inches
French Drain Required: Linear feet
Authorized State Agefit— Date