OPHTE# (Q�-5-N331� Harnett County Department of Public Health 24978
PERMIT # aq?tf1 �9'eration Perm*--
d New Installation Septic Tank Nitrification Line ❑ Repair ❑ E
PROPERTY LOCATION: 9151 51+ec;< TaMnv.n OA _ (SR ISI
Name: (owner) S -TC-- GevaA CoAlratkotS SUBDIVISION LOT #
System Installer: G ,1lo riz:- Registration #
Basement with plumbing: ❑ Garage E❑ mber of Bedrooms 3
Type of Water Supply:C3 Community LK" Public ElWell Distance from well feet L+^ a)
/�
System Type: O.6% aeA %. rt.=
s Types V and VI 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 aoolicable North Carolina General Snwtes. Rules W S.. T...rm.nt .nd nismq Ind .n .nndann..r'k. i.,.n.,..,... D.—;, ..a r. ....... :...... .--: --- :
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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 sewa$S posal system on the above a boned property.
Type of system: ❑ Conventional C� Other Arte- 3 <, .� Septic Tank gallons Pump Tank:gallons
Subsurface No. of 1111 exact length width of depth of
Drainage field ditches t of each ditch feet ditches 3 feet ditches a0 inches
French Drain Required: Linear feet
Authorized State Agent Date
s
sa` --A�Z���jj.-
S.11r�
392 5a:r�
16')(64'
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewa$S posal system on the above a boned property.
Type of system: ❑ Conventional C� Other Arte- 3 <, .� Septic Tank gallons Pump Tank:gallons
Subsurface No. of 1111 exact length width of depth of
Drainage field ditches t of each ditch feet ditches 3 feet ditches a0 inches
French Drain Required: Linear feet
Authorized State Agent Date
I