OPHTE# 1 G 'S -1Y7'q Harnett County Department of Public Health
24428
PERMIT # 29637- eration Per it
New Installation EV Septic Tank Ltd' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5r--66 ec- C4
Name: (owner) 2 r 14�.Igr itv_.. SUBDIVISION 1%vc..1 Gien LOT # Z
System InstallerRegistration #
Basement with plumbing: ❑ Garage � rp'���--r of Bedrooms
5
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type:Types V and VI Systems expire in S years.
(In accordance with Table UVa)::) 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 Sutures, Rules for Sewage Treatment and Disposal, and all condmom of the Improvement Permit and Concannon Authorisation.
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PERMIT CONDITIONS
I. Performance:
Il. 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 ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewage isposal system;n Otlaebave captioned property.
Type of system: ❑ Conventional Other �' Tom/ Septic Tank: AIZ14n) gallons Pump Tank: gallons
Subsurface No. of exact length width of �. depth of
Drainage Field dirhes of each ditch y�% feet ditches S feet ditches 3O inches
French Drain Reouired: �mNr fpet
Authorized State Agent C411)a5 Date