OPHTE#~CQ -21873 Harnett County Department of Public Health 2 0 4 4 9
PERMIT # 2 it Z OReratl0n Per It
L~ New Installation Septic Tank El Repair Lid Nitrification line 1:1 Expansion
PROPERTY LOCATION:_, t 1-7 z,-~ gE q&4, C4.j, p,.b
Name: (owner) SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: L1 Community L~1 Public ❑ Well distance from well feet
System Type: ZUU RZOVrrit ) tl ff r091 gK G -P Z c.a y 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.
,rn¢in u- ueeu naranea in compoance wan 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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PERMIT CONDITIONS:
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
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 12' Other 2S% /V-boe,i7&1 Septic Tank /bt>a gallons Pump Tank: gallons
Subsurface No. of f exact length width of depth of
Drainage Field ditches of each ditch /ba feet ditches feet ditches 14 inches
French Drain Required: Linear feet
Authorized State Age
Date ' L b 9
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