OP RHTE# -S -` ibaG2 Harnett County Department of Public Health
24713
PERMIT # Zai 3 a a 00 �r-ation Permit
Q-1ew Installationeptic Tank LI—Nif4rification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Zt' yc44 -A¢ S11 W-110
Name: (owner) 06CN �onsEr ��� r �-1c SUBDIVISION A e.- LOT #
System Installer: 1 Registration #
Basement with plumbing: ❑ Garage umber of Be rooms _l54—
Type of Water Supply: ❑ Community Ci-llukfic ❑ Well Distance from well vh feet
System Type: ZeOo 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.
[his 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 Comtmrtion Audturindon
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dji poral system on the above captioned property.
Type of system: ❑ Conventional Wither /—/v > 11[=k Septic Tank: 11. Sy gallons Pump Tank: 1 Ot5b gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch C6O feet ditches 3 feet ditches Ze—aa inches
French Drain Required: Linear feet
Authorized State Agent.���