OPHTE# I � - s - 3 990$ Harnett County Department of Public Health
24418
PERMIT# 25303 0 ation Permi
lew Installation Rleptic TankItrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Ci�ttor2 CT-ocac� C 5M 1479)
Name: (owner) GS 34-' Tne. SUBDIVISION t: AIA P o � n (e- Q H -t11Z LOT # W
System Installer: Registration #
Basement with plumbin,El Garage yNN her of Bedrooms —
Type of Water Supply: ❑ Community f Public ❑ Well Distance from well feet
System Type: ZS` Types V and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
lms System ha: been msulled in romplianoe with appliable North Carolina Geneml Stawtet Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Commimon Aothorixafion.
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PERMIT CONDITIONS
I. Performance:
11. 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 la/
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage i posd system on the above captioned roperty.
Type of system: ❑ Conventional Other /%� /�/b� �. Septic Tank: 1 C'O6 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch �— feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State AgentDate OPe IZ f zot"T
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