OPHTE# /f r--71 IL% Harnett County Department of Public Health 23946
PERMIT# �e`tYJ 0 eration Permit
New Installation Septic Tank Q' l6ification line ❑ Repair ❑ Expansion
�pD S, J PROPERTY LOCATION:
Name: (owner) 'io, �e--r Thr.+•✓' SUBDIVISION LOT # <Zaza
System Installer: 41- c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Ler' Public ❑ Well Distance from well feet
System Type:/!i 9 _ 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 Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No Err
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLfne ❑ PWR Line
rOY'ty
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
21`5'06ther r2F/ou.a
Septic Tank: WD gallons Pump Tank gallons
Subsurface
IMN
exact length
width of depth of
Drainage Field
ditches
of each ditch JOy feet
ditches 3 feet ditches inches
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No Err
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLfne ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
21`5'06ther r2F/ou.a
Septic Tank: WD gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch JOy feet
ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Ag
Date
IS 5 _37 40