OPHTE# X5 ,5�G561 Harnett County Department of Public Health
23926
PERMIT # Z8(-1 y Operation Permit
New InstallationSeptic Tank /�C�Nitrification Line El Repair El Expansion
PROPERTY LOCATION: ISO Ak-it (2�IC
Name: (owner) ����k S :{� SUBDIVISION � �� �-af C—.r� LOT # 3C
System Installer: /e aJ i a (aJ! Registration #
Basement with plumbing: ❑ Ga graGa gra eT❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 172"'Public ❑ Well Distance from well feet
System Type: t�o 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 applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authomation
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 01
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Bax ❑ Pump ❑ Alarm ❑ H2OLine
Following are the specifications for the sewa disposal system on the abov captioned property.
Type of system: ❑ Conventional Other a�cc-�L C�a.+S� Septic Tank: /0C) C) gallons
Subsurface No. of exact length width of
Drainage Field ditches 02 of each ditch 7U feet ditches feet
no
PWR Line
Pump Tank: gallons
depth of
ditches Q? "l--30 inches
French Drain Required: Linear feet
f//�' /
Authorized State A t 111 Date
x,5,36'(61