OPHTE# l6 - 5 - 3`t Harnett County Department of Public Health
24439
PERMIT # z8 I b eration Permit � �
EY New Installation eptic Tank itrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: A+yi'ns a.�N.
Name: (owner) _RDyul NaV—e aal.A . (� . SUBDIVISION 44V i fts V : AtpA_ LOT # 3!S
System Installer: Registration #
Basement with plumbing: ❑ Garage lsd" �� tuber of Bedrooms
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 V a) Awner 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 Authorization
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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No IV
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 sewa Isposal system on the above captioned property.
Type of system: El (a Ier %6%s f2tLxa<:pn ra t- Septic Tank: 71 00 gallons Pump Tank: gallons
Subsurface No. exact length G width of depth of
Drainage Field ditches of each ditch IS feet ditches 3 feet ditches inches
French Drain Required: feet
Authorized State
Date
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