OPHTE# 7(zs53 Harnett County Department of Public Health 23922
PERMIT # o28 cf ;L3 1 eration Perm'
ETINew Installation Septic Tank Vitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:yJ l ( L�co✓
Name: (owner) SScT SUBDIVISION axe{ p { w LOT # / 7
System Installer: r,4--L Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -�
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: q 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
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑
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H2OLine ❑
Following are the specifications for the sewage disposaVl �l jystem on thf al�v captioned property.
Type of system: El Conventional El Other u; c k `+ `zj -, 'W— Septic Tank: ou Q gallons Pump Tank.-
Subsurface
ankSubsurface No. of exact length width of depth of
Drainage Field ditches / of each ditch a3 0 feet ditches 3 feet ditches y0
French Drain Required: Linear feet
Authorized State Ag &'r1v/1�
Date
PWR Line
gallons
inches
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