OPHTE# tq-5-14145 Harnett County Department of Public Health 24843
PERMIT # i`156a OODeration Permit
E�- 1ew Installa�pS to TankrtrdL�i�'Ityti�ne ❑ Repair ❑ Expansion
Name: I (owner) 5
PROPERTY LOCATION: &'I &'qj P� D, ce s, b4e ,e na se- 60)
t -r�� (c 5(e �L•- —T SUBDIVISION �1 to LOT # ; J
System Installer: Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms —
Type of Water Supply: ❑ Community El-#cbric�❑ Well Distance from well ^4al— feet
System Type: 5 - 5 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 0 must contact Health Department 6 months prior to expiration for permit renewal.
Ims system has been installed in znmplianre with applicable North Carolina General Statutes. Rules for Sewage Treament and Disposat and all conditions of the Improvement Permit and Conmulsion Authorization.
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PERMIT CONDITIONS -
1. Performance:
11. 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 ❑ Alorm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage 9� system on the above captioned oraoerty.
Type of system: ❑ Conventional Other aC� i(p�;.� '—I V� Septic Tank gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches s of each ditch feet ditches 3 feet ditches /f� inrhnc
trench Oram Required: Linear feet
Authorized State Agent Date I l a y ab l