OPHTE# 1Z -' - Z'M-/S— Harnett County Department of Public Health
PERMIT # Z77—a9 / ep ration Pe It 22472
Q New Installation LA Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: - si—t S orb
Name: (owner) t— r SUBDIVISION io -E icw b: %k LOT # I
System Installer: Cij Registration #
Basement with plumbing: ❑ Garage /Number of Bedrooms 3
Type of Water Supply: El Community ;Public ❑ Well Distance from well feet
System Type: GZ Types V and VI Systems expire in 5 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 conditio -A-e Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewaje disposal system on the above captioned property. .qy
Type of system: ❑ Conventional Other L<% d2-4—lb d2-4- U �� — r Septic Tank: — I QD(D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch / 2+) feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age Date 12
12 -5 -29845 (1)
12 -5 -29845 (2)
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12 -5 -29845 (4)
12 -5 -29845 (5)
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12 -5 -29845 (9)
12 -5 -29845 (10)