OPFITE# oq-s 1 Harnett County Department of Public Health 2 0 8 7 6
PERMIT # 25-`f t: - Operation Pe lt
New Installation E Septic Tank ❑ Repair /Nitrification Line ❑ Expansion
PROPERTY LO(ATION:-T,~37 S4,&t. zW
Name: (owner) /o~~ erns. D -L- ir>c SUBDIVISION LOT #
System Installer. i/ Registration #
Basement with plumbing: ❑ Garage 5umber of Bedrooms
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: ZSs/bl"7® % yew ITT ~z ~'Kj 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.
mis system nas peen mstanea in compnance wim applicable Norm larouna beneral Statutes, Rules for
Treatmjtlr\and Disposal, and all conditions of the lit
Permit and construction Authorization.
JJCfJs C 14-414-11 t._r.J Tv i3>r
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L Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 sew )(e disposal system on the above captioned property.
Type of system: ❑ Conventional Other ~~5 jLLZ~VU f Scs Septic Tank: {DOD gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch -7 S feet ditches 3 feet ditches 21 inches
French Drain Required: Linear feet
Authorized State Ag Date 9 ' ✓y
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