OP-Cannot sign off permits not issued per DJHTE# 11.6-4o6su Harnett County Department of Public Health 24636
PERMIT # IQEtKeration Permit . ��
New Installation D eptic Tank fi�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3451 .ac Zt�
Name: (owner) & SUBDIVISION LOT #
System Installer:__s/(�:'Llnaa 1 "} (Sra dwell Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 9)('r w/ 36o r p
Type of Water Supply: ElCommunity D Public ❑ Well Distance from well feet D cAeK, rV
System Type: Ci Ail. ( r. v t [ 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.
INS s nm has been installed in compliance with appliable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authomabon.
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PERMIT CONDITIONS:
L Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
ill. 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 ❑
Following are the spedionsfor the sewage disposal system on the above captioned property.
Type of system: CoLK nventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches ti of each ditch Iu feet
French Drain Required: Linear feet
Alarm ❑
H2OLine ❑
PWR Line
Septic Tank: 10 0 o gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 36 inches
Authorized State Agent C/ Date v-7/ It f'ZG!
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