OPHTE# /3 - 5" -fzyg3 Harnett County Department of Public Health 23329
PERMIT # 2 77/ 0 0 erp ation Per
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATIONOX lg f 7
Name: (owner) �''vn- 1u,�i/w� / 0 1saG SUBDIVISION b tLC6b—,gP LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Cam] Public ❑ Well Distance from well feet
System Type: {'3 Types V and VI Systems expire in 5 years.
(In accordance with able V a) Owner must contact Health Department 6 months prior to expiration for permiwal.
This system has been installed in compliance with applicable North.Carolina General Statutes, Rules
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
V
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
and all conditions of the Improvement Permit and CXstruction Authorization.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box ❑ I Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewaa disposal system on the above captioned property.
Type of system: El Conventional L1 Other 15% W0 Septic Tank: 1A---N gallons Pump Tank: /0161 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches q of each ditch -lob feet ditches 3 feet ditches — 2q inches
French Drain Required: Linear feet
Authorized State A Z I W, Date /0 _C't — � 4f
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