OPHTE# I L - S_ -mss R Harnett County Department of Public Health 24212
PERMIT # /OOperation Permit
IJ New Installation C3 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: `Fig! yy 53 / !Z/,
Name: (owner) SUBDIVISION iTi� Orfiv��LOT #
System Installer: N Koji= 5 ri, Registration #
Basement with plumbing: ❑ Garage 121 Number of Bedrooms t-%
Type of Water Soppy. 0 Community Lvr/ Public ❑ Well Distance from well feet
System Type: te '7.,A; t' G �'rZ 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 sys wa has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal,. and all conditions of the Improvement eermrt and Lonstmcnon 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 ❑ H2OLine ❑ PWR Line
Following are the
specifications for
the sewa,disposal system on the above captioned properly.
Type of system:
ElConventional
C1 Other 1�%
Septic Tank /Z �r—O gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
3
Drainage Field
ditches
Ic! of each ditch feet
ditches feet ditches Let—)fi inches
French Drain Required: Linear feet
Authorized State Agents -e-- -5 Date
16-5-38588 (1)
16-5-38588 (2)
16-5-38588 (3)
16-5-38588 (6)
16-5-38588(7)
16-5-38588 (8)
16-5-38588 (4)
16-5-38588 (9)
16-5-38588 (5)
16-5-38588 (10)
16-5-38588 (11)
16-5-38588 (16)
16-5-38588 (12)
16-5-38588 (13)
16-5-38588 (14)
16-5-38588 (15)