OPHTE# -3 Yle, 4Z Harnett County Department of Public Health 24131
PERMIT # Z960 Aeration Permit_
Ci New Installation peptic Tank ttrification Line El Repair ❑ Expansion
PROPERTY LOCATION: Chu l G 4F� 2 tyZ 5
Name: (owner)- CorMrxX�' aA T_y t' SUBDIVISION A_aa r- and LOT # 3Y -
System Installer: Y+ a r--� o 1%"s P1 vM Registration #
Basement with plumbing: ❑ GarageN her of Bedroo 4"
Type of Water Supply: Ll Community ublic ❑ Well Distance from well feet
System Type: Z-6 %n 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.
110 U-11 noLdneo m wniPona Min appnmme moron uronna neneras satires, holes for sewage treatment no msposal, and an conditions of the lmpmrement Permit and construction Authorization.
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
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwa °Alsposal system on the above optioned property.
Type of system: ❑ Conventional [?"Other 25%v i%ia�tY�-iM %" I n Septic Tank: 1 Z00 gallons Pump Tank: IOCyC> gallons
Subsurface No. of exact lengthwidth of depth of
360Drainage field ditches of each ditch � feet ditches 3 feet ditches ZZ-- t6 inches
French Drain Required: Linear feet
Authorized State
/?APO -5 Date
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