OPHTE# 11-5 - 4Yrp Harnett County Department of Public Health ')A I 3 6
PERMIT # a 95e-1, Owation Permit
L�J' New Installation 2Teptic Tank EY—Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t 4*� � r—,„ti Vr ( vS 4/a ,J)
Name: (owner) _ 5 F �C,t ns�� A) &a, yr,c SUBDIVISION _ t^ a n + G c LOT # _
System Installer: Su hdc�44e_ Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 5L
Type of Water Supply: ❑ Community �❑ Well Distance from well q feet
System Type: 261'a 5,:— Types V and VI Systems expire in 5 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 Gmmral Sutures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constru tmat Authorization.
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PERMIT CONDITIONS:
I. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring:
As required by Rule .1961.
III. 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
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage dji pesal system on the above ca tltl ed roperty.
Type ❑
of system:
Conventional ❑?6ther �� rllo X111 y
Septic Tank to 6d
gallons Pump Tank: gallons
Subsurface
exact length
width of
depth of
Drainage Field
ditches
es
ditches 3 of each ditch Sod feet
ditches 3
feet ditches 18—'>2 inches
French Drain Required:
Linear feet
Authorized State Agent Date