OP RHTE# )1-S-461VI. Harnett County Department of Public Health 24635
PERMIT #11Y11 peration Per 't
New Installation E315eptic Tank LYNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ry AAoc,rr% aA - ( So Isg4)
Name: (owner) Sia d SUBDIVISION LOT # I
System Installer: 5Lunc l t1u;1 s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Sup ly: El Com munity El Public L?- Well Distance from well j 5 feet
System Type: 5�5 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
IDrs 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 Conmuaion Authonzanjon
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
ll. 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 ❑ H2OLino ❑ PWR Line
Following are the sped ons for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other Septic Tank: 1> gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of 44
Drainage Field ditches Z of each ditch 1 5c�' feet ditches —3 feet ditches Zvi ie2 inches
French Drain Required: Linear feet
Authorized State Agent ��� Date /10 to 14
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