OPHTE# I'l-5 'it 93 Harnett County Department of Public Health 24867
PERMIT# 0 eration Permit
New Installation Septic Tank 2�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: s-54, MCS j 4,n . Lie a1
Name: (owner) SUBDIVISION % LOT #
System Installer: r3�bb� —>� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public P Distance from well t o5 feet
System Type: Sir . ✓& - 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 appliable North candies General Statutes, Rules for Sewage resonant and Disposal and all m ' ons oft rorement Permit and Constluuion Authorization
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PERMIT CONDITIONS
I. Performance:
If. 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.
❑
/ i pos�u
Pump ❑ Alarm
❑ H2OL1na ❑ PWR Line
Following are the specifications For the sewage dais sal system on the above captioned roe
Type of system:
I I�.SFg t%1
P� 7la•;.�
Septic Tank: ICxYJ gallons Pump Tank: gallons
Z
No. of
-
width of depth of
Drainage Field
ditches 3
wt<cc
MF -ac I
SEW
A
V
I
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
❑ H2OL1na ❑ PWR Line
Following are the specifications For the sewage dais sal system on the above captioned roe
Type of system:
❑ Conventional LYOther
P� 7la•;.�
Septic Tank: ICxYJ gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 3
of each ditch I CX> feet
ditches _3 feet ditches A& inches
French Drain Required: Linear feet
avid
Authorized State Agent �- ���`9�� Date l a a
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