OPHTE# 15- 10:3 Harnett County Department of Public Health 24922
PERMIT #aV61 eration Perml /
New Installation eptic Tank ®/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: %b - Lfol t G M1L C R e &-. lz-
Name: (owner) 1-c:CKq Sc✓S SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Nu� of Bedrooms =
Type of Water Supply: ❑ Community LJiPublic ❑ Well Dista cam well feet
System Type: q5(b /��ss�'�jr �i Types V and VI Systems expire in S years.
(In accordance with Table V a) IOwnerm st contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Norah Carolina General Stamm, Rules for Sewage Treatment and Disposal, and all wnditions of the Improvement Permit and Construction Authorization
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_
❑ Pump ❑
33` -
s ` I
the sewage sal system on the aboveca tinned property.
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❑ Conventional
Other Aon
,
yo
Subsurface
No. of
exact length
tai
width of depth of
3
Drainage Field
ditches
of each ditch
(L
ditches feet ditches inches
5
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PERMIT CONDITIONS
1. 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:
Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for
the sewage sal system on the aboveca tinned property.
Type of system:
❑ Conventional
Other Aon
,
Septic Tank X00 gallons Pump Tank: gallons
Subsurface
No. of
exact length
L40
width of depth of
3
Drainage Field
ditches
of each ditch
feet
ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date 03 1 c`l IR
SE
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