OP RHTE# 19-5-4"ydAe Harnett County Department of Public Health 24868
PERMIT #a5Operation Perm
New installation
Tank itrification Line ❑ Repair ❑ Expansior
t." A nc . PROPERTY LOCATION: 35 as G 0 u 5 Ndl
Name: (owner) n.+'C-k,. Lc,,,A 96,A z5i SUBDIVISION Mane 93 ik tz;dyf LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage fir of Bedrooms
Type of Water Supply: ❑ Community E;i— fi c ❑ Well Distance from well ^'A feet
System Type: 2.f k s s. —K� 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 applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constmaion Authonaation.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 ❑ 14201-ine ❑ PWR Line
Following are the
specifications for the sewage disposal
system on the above captioned property.
Type of system:
❑ Conventional M-�fiher
C-7� r—t - s �
Septic Tank: 16U 0 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches '�
of each ditch R V U feet
ditches feet ditches l �5 --y 3�;' inches
French Drain Required: linear feet
Authorized State Agent Date
iy a at 8