OPHTE # 15-S-3cl'R Harnett County Department 1Public
PERMIT # ) Aeration Permit
New Installation );� Se tic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: v Nr�ifv G C� Q
Name: (owner) M 0 �'5 G SUBDIVISION Um'M0>`T LOT # `3 C
System Installer: L.WG-t.- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communi A Public ❑ Well Distance from well )1 00 feet
System Type: 1 1 } 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.
INS 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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D[DMIT f'A lIn I71n11[.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ I Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the ewage disposal s stem '
on the above cap oned property.
Type of system: El Conventional Other Ulm-�Septic Tank: $ a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3 40 feet ditches 3 feet ditches 1? -315 inches
French Drain Required: N irwu feet
Authorized State Agent �`\ 04AU Date `I