OPHTE#T s -s 36�5a
PERMIT #�113a
Harnett County Department of Public Health 24290
New Installation Septic TankNitrification Line ❑ Repair
PROPERTY LOCATION: Meq. -e.5 QP (owner)N\ [ v.¢Nd.5 SUBDIVISION LOT
System Installer. ') oAKL?G Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 7— a
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well t 00 feet
System Type: = c_ 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.
❑ Expansion
This system has been installed in compliance with applicable Notes Carolina General Smmtes, Rules for sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constromon Authorization
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑
❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface _ No. of exact length
Drainage Field d—RcRer, I of each ditch IUD feet
French Drain Reauired:�%-- \ -'Bimar feet
H2OLine ❑
PWR Line
Septic Tank: 11500 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches�—�� inches
Authorized State Agent Date
0
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