OPHTE # I/'/ - 5"'—,33& ZZ Harnett County Department of Public Health 23340
PERMIT # Z,7 Operation Peter
LQ New Installation Septic Tank 2---Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONS '?34 Ac 26w 46
Name: (owner) SUBDIVISION <7'O LOT # =
System Installer: edkze Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .3
Type of Water Supply: ❑ Community 0"Public ❑ Well Distance from well feet
System Type: r Types V and VI Systems expire in 5 years.
(In accordance with able V a) 0 ner must contact Health Department 6 months prior to expiration for permit renewal.
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tnts system nas neen mstauea in compuance w¢n appocame noun tarorma uenerai mime, Wes ror sewage ireatment ana uisposai, ana an commons or me improvement rermir ana construction eumorizanon:
1®M
10
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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.
➢— x
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewaisposal system on the above captioned property.
Type of system: El tional Conven I� Other 2M �� y f Septic Tank: t °"� ° gallons Pump Tank: ` °' `a gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches MAN inches
French Drain Required: Linear feet
Authorized State Agent Z t,J 4q— Date
a
a
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♦ ,w
14 -5 -33622 (7) 14 -5 -33622 (8)
14 -5 -33622 (9)
14 -5 -33622 (10)
14 -5 -33622 (11)
a
14 -5 -33622 (17)
14 -5 -33622 (18)
14 -5 -33622 (19)
14 -5 -33622 (1)