OPHTE# S-5 -3naa Harnett County Department of Public Health 24009
PERMIT # ano6 Operation P
New Installation V Septic Tank )9r Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I aL> Lvca5 Qp
Name: (owner) �-st r ari,c��+ SSC. SUBDIVISION ErL LOT # 33
System Installer. H KcLyN.4 Jrc@ C\ G- Registration #
Basement with plumbing: ❑ Garage V Number of Bedrooms
Type of Water Supply: ❑ Community �K Public ❑ Well Distance from well 1156 feet
System Type: Types V and VI Systems expire in S 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 Authorisation
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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 ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional I Other E Z 'Fiou Septic Tank: 16 r3 d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches � inches
French Drain Required: Linear feet
Authorized State Agent wQ5 Date 4146
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