OPHTE# 1(e s � 3yOsj Harnett County Department of Public Health 24405
PERMIT # Z9G6L eration Per jj�--
New Installation Septic Tank itnfication Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: ),de—aw?s— rcD s,>_ cvz_g)
Name: (owner) 1NYNN C.Oy ST(lJ4 t N zeic SUBDIVISION LOT # L�
System Installer: 7-141 eLl , JNi rt ArRegistration #
Basement with plumbing: ❑ Garage 2 21'Nu*r of Bedrooms
Type of Water Supply: ❑ Community [?'Public ❑ Well Distance from well feet
System Type: '7--57, Types V and VI Systems expire in S years.
(In accordance with Table V a) Owoe must contact Health Department 6 months prior to expiration for permit renewal.
]his system has been installed in compliance with applicable North Carelina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961. j
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No CIr
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ —D -Box ElPump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewaCA3115-SaT system on the above caboned property. itco
Type of system: ❑ Conventional Other e; ro -- 5 Septic Tank: 04010' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches s of each ditch 6 y feet ditches �i feet ditches Z inches
trench Drain Required: Linear feet
Authorized State Agent Date OS !b /7-01 -;:f
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