OP RHTE# S--A7// ~AC Harnett County Department of Public Health
PERMIT # a Operation_ Permit 2 21 5 8
dNew Installation C✓( Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: .'YAD.r A°4stl.1,6 .0.
Name: (owner) 1 t c~,~ cA, c 0 y' t cJ SUBDIVISION J-A r?,4 ,q,:~r LOT # 9
System Installer: 0 C. Cc.-,-k- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: ri4-G;- Types V and VI Systems expire in 5 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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DCOMIT rn►InITlnuc. -
1. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Pump ❑ Alarm ❑
H20Line ❑ PWR Line
Following are th
e specifications for the sew a disposal system on the bove c ptioned property.
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Type of system:
❑ Conventional
Other 6o
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Septic Tank:
Q~ gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches j
of each ditch G feet ditches
3 feet ditches 18`40 inches
French Drain Required: Linear feet t
Authorized State Agen Date l _T7 v2-
11'5-"c.2 71 / I /e-
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VIA
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