OPHTE# 1 -1-swo;�O Harnett County Department of Public Health 24741
PERMIT # '�'�S OlDeration Permit
New Installation Septic TankX Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: WQg6fcv7 19D
Name: (owner) "Li loo G�&R"t,5p1'Lb IN(-- SUBDIVISION N.00F,v LAc F s LOT # C Lj
System Installer: S� q�cR. r'j Registration #
Basement with plumbing: Cl Garage Number of Bedrooms LJ
Type of Water Supply: ❑ CommPublic ElWell Distance from well feet
System Type: T A 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 Improrement Permit and Commuction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑ 112O1-ine
❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above ca tione roperty.
Type of system:
El Conventional
X Other GHLIMte i�L
Septic Tank lit oy gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
3 of each ditch `2 V feet
ditches � 3 feet
ditches WA -30 inches
French Drain Require : Linear feet
Authorized State Agent 1 +Z4\' Date �1 )
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