OPHTE# 14 -s -yv13G Harnett County Department of Public Health 24397
PERMIT # Z 4 Z4 Z A 0 enation Permit �/
53" New installation Tank E Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:-oolr,,A be, sti tJlW.,Lr.ILA Sri 1q L9
Name: (owner) LJ „e- SUBDIVISION Aver„ Pa,nct LOT # t I
System Installer: 'T ti, k.A< PloM6', n , Registration #
Basement with plumbing: ❑ Garage umbe f Bedrooms _14—
Type
—Type of Water Supply: ❑ Community L1,,FGbIic ❑ Well Distance from well feet
System Type: Z_S 5,, /Lc.1 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.
Ibis system has been Installed in compliance with applicable Rorty Urolina General Smmtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (onstm<tion Authorization.
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PERMIT CONDITIONS: c a q N a
I. Performance:
If. 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.
❑ D -Box ❑ Pump ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage sposal system on the above captioned property.
Type of system: ElConventional er Z5 icy Toa Septic Tank t OOtj gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch X00 feet ditches 3 feet ditches �� 1� inches
French Drain Required: Linear feet
Authorized State Agent Date
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