OPHTE# C7—y'oc—`CD7d'+
PERMIT # j9yo1
Harnett County Department of Public Health 24705
Name: (owner) 51-4
System Installer: �i9 L & n dis",
Basement with plumbing: ❑ Garage 01 her of Bedrooms
Type of Water Supply: ❑ Community Pub El El WV
System Type: .2 S .Qo `}
(In accordance with Table V a)
in compliance with applicable North Carolina General
Operation Permit
I� New Installation @Septic Tank IJ? Nitriliication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M -,zo zN n "W /?ii -
SUBDIVISION LOT #
Registration #
from well A40' feet
Types V and VI Systems expire in S years.
ust contact Health Department 6 months prior to expiration for permit renewal.
Rules for Sewaee Treatment and
Permit and Constromon Authorization.
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 sewag�jisPosal system on the above captioned grope
Type of system: fi?�Conventional [?'Other Sl &ha.n /5, ' Septic Tank: gallons Pump Tank: ✓ gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 d Q feet ditches �_ feet ditches 1049 inches
French Drain Required: Linear feet
Authorized State Agent e-7 /Lem 17 'r^'`/bl - a/ /i' I,- •/ice Date
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