OPHTE# (ts s sid?ea Harnett County Department of Public Health 24409
PERMIT # -0 L4- f' 0 enation Permit �
New Installation eptic Tank Pr Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: V5 rt ' sa wjal
Name: (owner) S&f c;l B"IkCC5 SUBDIVISION LOT # q
System Installer: 0 m Registration #
Basement with plumbing: ❑ Garagelu3
r of Bedrooms
Type of Water Supply: ElCommunity CYPublic� El Well Distance from well feet
System Type: 25.E 4A11-c—%.s o n Y' -co Types V and VI Systems expire in S years.
4A11 -c—%.
(In accordance with Table V a) Owner 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 Authorimoon
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 sewage ' osal system on the above captioned property.
Type of system: ❑ Conventional Ther 25 c r va /Z t /lo- Septic Tank: G60 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch t UU feet ditches 3 feet ditches Zf� inches
French Drain Required: Linear feet
Authorized State Agent s�� �%'� Date CU to GI
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