OP RHTE# Aq -5-ya-CVe- Harnett County Department of Public Health 24939
PERMIT # 5Doe-ration Permit
New Installation eptic TankNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 385 C� k4Ay— LuY e— (L ,
Name: (owner) "oAzAt.--�- SUBDIVISION LOT # 3S
System Installer: Tis res tvc-T :r Registration #
Basement with plumbing: ❑ Garage Q- umber ��drooms
Type of Water Supply: Community C; --nu is 0 Well Distance from w I;\/ feet
System Type: 5i0 C1P��'C kj c)r\ 9) 44tsNt Types V and III Systems expire in 5 years.
(In accordance with Table V a) Owner must Health Department 6 months prior to expiration for permit renewal.
This system has been imalled in compliance with applitable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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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 f�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2O1-ine ❑
PWR Line
Following are the specifications for the sewage di ystem on the above captioned r
Type of system: ❑ Conventional they
t t` [ O h7
Septic Tank: gallons
Pump Tank: gallons
Subsurface No. of
Drainage Field ditches q_
exact length
of each ditch eO feet
width of
ditches 3 feet
depth of ,)
ditches aY inches
French Drain Required:
Linear feet
Authorized State Agent
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