OPLITE# —3gf8S Harnett County Department of Public Health
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24377
PERMIT# y3eratiPermit
Installation Veptic Tank L>d'"Nitrification Line ❑ Repair ❑Expansion
PROPERTY LOCATION: M -4-m-, Rd.
Name: (owner) Ro;Ia,1 Qck 311- (-ria. SUBDIVISION AWZRnS V: II c;- l LOT # �6
System Installer: Vknm'S n i, 11 Registration #
Basement with plumbing: ❑ Garage E� NN ber of Bedrooms �—
Type of Water Supply: ❑ Community L ublic ❑ Well Distance from well feet
System Type: Z `" b Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
]his System bas been installed in compliance with applicable North Carolina General Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consrmction Authorization
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25 �� (t.�zO JCTIVN rr rba 121 121 111 s
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
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 sposal system on the above captioned property. Qom;
Type of system: El Conventional Other ZS% (LA. Ap43A (,WA* Wi Septic Tank: I 0 gallons Pump Tank: I( cx) gallons
Subsurface No. of exact length yp', 44r 60, Cq width of depth of
Drainage Field ditches 6 of each ditch (o IC i --Z feet ditches 3 feet ditches g inches
French Drain Reauired --,- Linear feet
Authorized State Agent ",�" , fzvhs Date
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