OPHTE# tg - 5 - 3 AIWI Harnett County Department of Public Health 24711
PERMIT # ZCIQft Operation Permit /'
❑ New Installation El Septic Tank p�Nitrification Line UP-1epair ❑ Expansion
PROPERTY LOCATION:_ 3 a I A,—toot' Gr es4- /—n . (-Sri "Ic- a �4i�
Name: (owner) C?.� wea\«cam SUBDIVISION N. \Q2(- C(y-Q"g LOT # t
System Installer: 2 f LAe5;�3 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 14—Plific ❑ Well Distance from well feet
System Type: 5"v a ti s Types V and VI Systems expire in S years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliana with applicable North Carolina General Stamm. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorintion
PERMIT CONDITIONS
I. Performance:
II. Monitoring
III. Maintenance:
IV. Operation:
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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.
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V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ 1,1201-ine
❑ PWR Line
Following are the
specifications for
the sewage dis al system on the above captioned property.
Type of system:
❑ Conventionalter
Q`1 T
Septic Tank: �X i gallons
Pump Tank: gallons
Subsurface
No. of
exact length
3
width of
depth of
Drainage Field
ditches
of each ditch feet
ditches feet
ditches inches
French Drain Required: Linear feet
Authorized State Agent Date �c