OPHTE#)�-s-y" C6 Harnett County Department of Public Health 24926
PERMIT # �1�G� ration Permit
New Installation eptic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 934 cl vS plot k,_a
Name: (owner) (6664 Gctz, S 6-e_a_ Q> (Ae, S , SUBDIVISION n LOT # `t -
System Installer: pe—nn:b fAG-a\:n Registration #
Basement with plumbing: ❑ Garage ❑ Num °� Bedrooms 3
Type of Water Supply: ❑ Community Eil Public ❑ Well Distance from well feet
System Type: r' .avt,L: h Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must calfact 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 rditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS: tzaeJ
I. Performance:
11. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑ 11201-ine ❑ PWR Line
Following are the specifications for the seewwage l system on the above captioned pro erty.
Type of system: ❑ Conventional IXOther C� FI .a �J.—<� Septic Tank fit_ gallons Pump Tank gallons
Subsurface No. of exact length^ width of depth of
�
Drainage Field ditches of each ditch �✓ feet ditches feet ditches a inches
French Drain Required: Linear feet
Authorized State Agent Date 3 \420%9