OPHTE# 1�—s-ylao3 Harnett County Department of Public Health 24669
PERMIT # Zry Iy,b eration Permit
New Installation eptic Tank ETlitrification Line ❑ Repair ❑ Expansion
PROPERTY LOfATION:
Name: (owner) (L,"- r3165 %nc. SUBDIVISION T>o LOT # i3
System Installer: q htvaAr Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Ua- u6lic ❑ Well Distance from well feet
System Type: 73&"" Oa A. , , „ >s Types Y and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ims system nas been matalled in compliance with applicable North Carolina General statures, Ault$ for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorisation.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 disposal system on the above captioonne„d. pe .
Type of system: ❑ Conventional "0 er r: -S rt. 11L— • Septic Tank gallons Pump Tank:gallons
Subsurface No. of Jz exact length width of depth of
Drainage Field ditches of each ditch 5O feet ditches .3 feet ditches a inches
French Drain Required: Linear feet
Authorized State Agent �% `� '��� //_�-��J� �t5 Date 0E5 F zb I =f