OPHTE# 17-5-glM Harnett County Department of Public Health 24657
PERMIT # C' Operation
Permit-
Vew Installation Septic TankiLT N trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L� C -.,jet -le 20. ( 52 lyu3)
Name: (owner) Ornber-64 14oAy—s Tnc, SUBDIVISION 5 LOT # Y'
System Installer. !s` ?eA l3ro") n Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community E4-11blic ❑ Well Distance from well feet
System Type: Z.Si 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.
This 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 l onstrumon Authorization
PERMIT CONDITIONS
I. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
PUrnO .0 25%
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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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
—D -Box ❑
Pump ❑
Alarm ElH2OLine 1-1PARLine
Following are the specifications for the sewage disposal system on the aboveeca tiiooned property.
Type of system:
El Conventional ❑ Other
Cho„rslue= - 11i1r:
Septic Tank: lCk�C� gallons Pump Tank rn�X'> gallons
Subsurface
No. of
3
exact length
—4(1
width of depth of
Drainage Field
ditches
of each ditch feet
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State AgentDate
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