OPHTE# 11-6-4dqS 3 Harnett County Department of Public Health 24678
PERMIT #Z�l1iA, eration Perini
New Installation Septic Tan Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 311A Axpeo
Name: (owner) 1,-)tinN SUBDIVISION Ave.D4 eel CA LOT # 5-7-
System
7System Installer. k h ; p Registration #
Basement with plumbing. ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Communityu lic ❑ Well Distance from well k— feet
System Type: ZS% rt eA. i sus tins--�- Types V 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.
This system has been installed in compliance with applicable north Carolina General Statutes, Rules for Sewage freatrnent and Disposal, and all conditions of the Improvement remit and konstructson Authorization.
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PERMIT CONDITIONS
I. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 ❑ H2OLme ❑ PWR Line
Following are the specifications for the sewage dual system on the above captioned property.
Type of system: El Conventional Other i:: b Septic Tank: j 70e gallons Pump Tank: f a 3C, gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches `3 of each ditch I(- c,C feet ditches feet ditches / inches
French Drain Required: Linear feet
Authorized State Agent E Date C1 I CEJ 11aOi�
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