OPHTE# BLS 25~f Harnett County Department of Public Health
PERMIT # Operation Per it 2 2 0 7 9
L( New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~ iZ' ~ 1zh
Name: (owner)- SUBDIVISION 1 s LOT
System Installer: / Registration #
Basement with plumbing: ❑ Garage hkifiber of Bedrooms - A3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Ax3) '16 06%1?~-'~ JQ' Az;r Vbd VI Systems expire in 5 years.
(In accordance with Table V a) weer must c ntact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nprth Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditiops of the Improvement Permit and Construction Authorization
rLnrui Lvivuinvn3.
1. 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
❑ H20Line ❑ PWR Line
Following are th
e specifications for the sewage disposal
ystem on the above captioned roperty.
Type of system:
El Conventional El Other
ys % 6,V6/2;h)
Septic Tank: 6 a v gallons Pump Tank: gallons
Subsurface
i
ld
No. of
di
h
5
exact length
h f
t
f
h di
width of depth of
i
dit
h
-3 f
t dit
h
h
Drainage F
e
tc
es 1
o
eac
tc
ee
c
es
ee
c
es
nc
es
French Drain Required: Linear feet
Authorized State Agefit_t~~ Date
"ti
10,
11-5-25513 (1)
f ~T J i
11-5-25513 (6)
.-77 c 2
1 Z
11-5-25513 (2)
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11-5-25513 (7)
11-5-25513 (3)
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n 6 4
ten/ f T
7 8
11-5-25513 (4)
11-5-25513 (8) 11-5-25513 (9)
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11-5-25513 (5)