OPHTE# IG—S-311 3 Harnett County Department of Public Health 24316
PERMIT # 2 D 39 0 eration Permit
530 New Installation VSepticTank Ei Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Ti ys f h ma n 2d.
Name: (owner) 11 (�u;OerS. Lt—C SUBDIVISION 6 arc M. En ns LOT # f
System Installer: Ke- n w—. h2' Registration #
Basement with plumbing: ❑ Garage VNmber of Bedrooms 3
Type of Water Supply: ❑ Community VPublic ❑ Well Distance from well feet
System Type: 'ZS°o �� fn Types V and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
This nem 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:
If. Monitoring:
111. 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 I/
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 6s Dther
6a f t o a Septic Tank
s o o O gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches 3
of each ditch i -S f..t nit.h..
Q r... .:..... 711—:_....
French Drain Require - linear feet
Authorized State Agent _ t *1 Date 17-/ 0 Z- 17—,C11-4
I � - 5-35103
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