OPHTE# 1-4 -5 -q6l�j5 Harnett County Department of Public Health
24417
PERMIT # 2 yan-.Operation Permit�,�
New Installation Septic Tank 0— Nitrification Line ❑ Repair ❑ Expansion
rt an W aGIoS�] PROPERTY LO(ATION: Z8P T,Ylen //ow, ,&A SJr . (old 2WI aZ qy
Name: (owner) t),a.U6Ec t W 2 f"AAA. S �Lc, SUBDIVISION (Awra,e 6e Tt CL',cloc_ LOT # zA
System Installer: L 5 h Registration #
Basement with plumbing: ❑ Garage Nu of Be rooms
Type of Water Supply: ❑ Community ( ❑ Well Distance from well feet
System Type: Zsyn l2casae- . oA 5 y s. 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.
This system has been installed in compliance with applicable North Carolina General Starnes, 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.
If. 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 sal system on the above captioned roerty.
Type of system: ❑ Conventional I5 ��
Other — ?4 s I Septic Tank: i UUU gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 8 5 feet ditches -3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent �6�� Date 0 G / t Z / ZU S-1
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