OPHTE# Harnett County Department of Public Health
PERMIT # Zfvf4,, Operation P snit 21 7 4 9
Id New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION:'S*4.1. % C,4-1
Name: (owner) Gat a ,tYt_ i M4 ' SUBDIVISION 4,411• f A ,4,r LOT #
System Installer: -11Y < Registration #
Basement with plumbing: El Garage Number of BeOtioms
Type of Water Supply: ❑ Community ❑ Public 0 Well Distance from well fG6~ feet
System Type: 602 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mist 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
IfAll~ :ment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
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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 ❑
Following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional Other N' 11 Mt- a rs~ ru Septic Tank: C Lib
Subsurface No. of exact length width of
Drainage Field ditches of each ditch O feet ditches ?1
H20Line ❑ PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches iz M inches
French Drain Required: Linear feet
Authorized State A t ~i Date i
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11-5-26096(11)