OPNTE# 1 - 5 - y/bl3 Harnett County Department of Public Health 24145
PERMIT # Q551 0 .oration Permi - �
lew Installation Septic Tank 0 -Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 56 Sae />lo w a C - y - e1oj
Name: (owner) eyw nso� c3i�s .�. SUBDIVISION �`�� �r�e� t LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms_
Type of Water Supply: ❑ Community c ❑ Well Distance from well A feet
System Type: 00'. iGc.� �— Types V and VI Systems expire in S years.
(In accordance with Table V a) ner 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 Consuuaiun Authorisation
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 ❑
Following are the specifications for the sewage dis system on the above capti�roperty.
Type of system: ❑ Conventional l 57 �R �.1 41—_ Septic Tank: TO06 gallons Pump Tank:
Subsurface No. of n exact length width of depth of
Drainage Field ditches a of each ditch feet ditches 3 feet ditches
French Drain Required: Linear feet
Authorized State Agent Date
PWR Line
gallons
inches
0
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