OPHTE# 0 j - - - ZZ-18! Harnett County Department of Public Health 2 0 8 8 7
PERMIT # z 3`t 0 eratI I
Femit
[New Installation I Septic Tank ❑ Repair ❑ Nitrification line /Expansion
PROPERTY LOCATION: sti issy dN~sn
Name: (owner) j&ssell ~i Y SUBDIVISION E3c&&' Poo LOT # 1_
System Installer Ke-,-j,,) 4k ~ Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms 3
Type of Water Supply: El Community L Public ❑ Well Distance from well feet
System Type: ~a Z~F' Fa Types V and VI Systems expire in 5 years.
(In accordance with Table V a)
7 Owner must contact Health Department 6 months prior to expiration for permit renewal.
-a >rxem nas peen msraoeo in compuance with applaable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
EX
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DCDMIT rY111r11TIA1/[.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 5~"h ,2Ebv~~}, s Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -7c' feet ditches _ feet ditches .2y inrhes
trench Drain Required: Linear feet
Authorized State Age 24 Date /0 -19- 61
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