OPHTE# # �° 3Z?-z Harnett County Department of Public Health 23217
PERMIT # Z7".5 `�.3 aeration Per It -
E _New Installation Z Septic Tank Nitrification Line ❑ Repair ❑ Expansion
P P
PROPERTY LOCATION
Name: (owner) Sit' 4rl, .mss_ �r� SUBDIVISION &,,k, LOT #
System Installer: 5 zz—E a�F Registration #
Basement with plumbing: El Garage DI mber of Bedrooms _
Type of Water Supply: El Community L Public ❑ Well Distance from well feet
System Type: ip s i _05- hypes V and VI Systems expire in 5 years.
'nlo (In accordance with able V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
Z
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 sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 15Other 751% % fCA)tt 741— Septic Tank: 101—"� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch a feet ditches -3 feet ditches -5 l it inches
French Drain Reauired: Linear feet
Date
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Authorized State A�enAgent 0-
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13 -5 -32223 (2)
13 -5 -32223 (3)
13 -5 -32223 (4)
13 -5 -32223 (5)
13 -5 -32223 (6)