OP RRHTE# IS -5-3-1)L1I3M Harnett County Department of Public Health 23986
PERMIT # a�ro3� 0 erati_� on Permit
New Installation 'X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: \44hv
Name: (owner) SUBDIVISIONH--, i1kNtl(1 LOT #_
System Installer: (%si s Registration #
Basement with plumbing: ❑ GarageX Number of Bedrooms
Type of Water Supply: ❑ Community -'Lk Public ❑ Well Distance from well feet
System Type: '-lis r. Types V and A 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 rermn and Lonsouction numomatwn.
l
(Z
PERMIT
)
300
�s
HovsDE
R
WstJ6£o�} Wim`)
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ H2O1-ine
❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'X Other
E Z. F's- aw
Septic Tank: f000 gallons
Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches l
of each ditch A`�Q feet
ditches feet
ditches I— inches
French Drain Required. �_
Linear feet
_
Authorized State Agent �\\ X13`' Date 3 a )1
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