OPHTE# 16 - S - v0'eZ4 Harnett County Department of Public Health 24411
PERMIT# Z9t3s 0 eration Permit �,��
New Installation Septic Tank L--fi rdtcation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: !het oE.:see 2r.+ 2 zoy8)
Name: (owner) Ues-<� SUBDIVISION LOT #
System Installer: c0c, G;I Registration #
Basement with plumbing: ❑ Garage Eirlumt Bedrooms 3
Type of Water Supply: LJCommunity Q;,Iu-blic ❑ Well Distance from well feet
System Type: LS /4,A c [ ;„Ec . � Types V and Yl Systems expire in 5 years.
(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 comphane with applieble North [melons 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:
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.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewagedisposal system on the above caption�ed�proPerly.
Type of system: ❑ Conventional M- they t52- v.) J lam-•, Septic Tank: i Ud
Subsurface No. of enact length width of
Drainage Field ditches 3 0( each ditch feet ditches 3
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches ZZ inches
French Drain Required: Linear feet
Date 06/ 0S 1 Z-0 1,4-
Authorized State Agent s
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