OPHTE# II, -5 �3-39 Harnett County Department of Public Health 24064
PERMIT # 28833 Operation Pe It
New Installation Septic Tank d Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION;rg ,la//s SGL]
Name: (owner) We" & -t- / nn= -m -r_wac SUBDIVISION 0L.wAu ill LOT #
System Installer: Ortilj-����ru,,\ Registration #
Basement with plumbing: ❑ Garage &�Number of Bedrooms
Type of Water Supply: ❑ Community f/ Public ❑ Well Distance from well feet
System Type: MUBZ4)zinx gill rn ttt G FZCay Types V and VI Systems expire in S years.
(In accordance with Table V all Owner must con act Health Deplirtment 6 months prior to expiration for permit renewal.
This system has been installed in comilliance with applicable North Carolina General Statutes, Rules for
PERMIT CONDITIONS:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
s
11 3`Spr� G
101
and Dislosal. and all conditions of she Improvement Permit and
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional fl Other % Septic Tank: 10 0 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 5'0 feet ditches feet ditches 2 y -� it inches
French Drain Required: Linear feet
-7Authorized State A - Date '7 -?4— 1,6
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