OPHTE# ►-1-5'�;alU` Harnett County Department of Public Health 25052
PERMIT # a�1 �� Neration Permit
New Installation � Septic Tank )I Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Cyea,6ss CJS,\.a 6
Name: (owner) oc,5tNc-SUBDIVISION 0\ooEft I-a,Y-C 5 LOT #a3fl
System Installer. TEo a r" H N Registration #
Basement with plumbing. ❑ Garage 1>—kl Number of Bedrooms
Type of Water Supply: ❑ Community___�?S Public ❑ Well Distance from well feet
System Type: Types V and A Systems expire in S 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 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.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required! Yes ❑ Max
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 disposal system on the above optioned p2ryperty.)
Type of system:
❑ Conventional
�( Other Puvne i o CIAO, ti6Q�
Septic Tank: 100[1 gallons Pump Tank: 1 0 C ❑ gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches—�
of each ditch 0.7 0 feet
ditches .3 feet ditches I -' inches
french Drain Required:
\ mar feet
Authorized State Agent \\ Will A5 Date