OPHTE# Ij-6-y)951 Harnett County Department of Public Health 24982
PERMIT # rration Perm
Ltd�New 'Installation 9�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 14 (a 104, Com. S1ccs /i.A 52 I i I
Name: (owner) Lc yirw Crs44crn ❑Ids,U.c— SUBDIVISION C.o1o„'d l l -Lt 1k S LOT # 6
System Installer: CIv S Registration #
Basement with plumbing. ❑ Garageum�� Bedrooms 3
Type of Water Supply: ❑ Community lYPublic ❑ Well Dista from well N6'- feet
System Type:�i% 54Types V and VI Systems expire in S years.
(In accordance with Table V a) Own ust contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nonh Carolina Genenl Sutures. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (omnc ion Authorization
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I. Performance: System shall perform in accordance with Rule .1961. A,-
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 57
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage oral system on the above caps one prope
Type of system: El Conventional AfIL. G1lmLc�c Septic Tank: LO gallons Pump Tank: gallons
Subsurface No. of exact length -K width of depth of
Drainage Field ditches of each ditch 'r'� feet ditches 3 feet ditches _�� inches
French Drain Required: linear feet
Authorized State Agent ./ Date CS,�cl�
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