OPHTE# Harnett County Department of Public Health
PERMIT # 0 erati0n-Per it 2 21 3 5
ZNew Installation E Septic Tank Rr Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 44
Name: (owner) C l S.u ~Q n 1 ~o ^V SUBDIVISION ITe l e ,Tom,,,/~ , LOT # 4
System Installer: C k~.,r m ; I ko Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: TLt_.B Types V and A Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ihis 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 Authorization.
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PFRMIT rmmnITInW-
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other 2v~^(~ ~b LZ~~gv s Septic Tank: /030 gallons Pump Tank: /000 gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 3 of each ditch /00 feet ditches -2 feet ditches /Z inches
French Drain Required: Linear feet
Authorized State Agent V__
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