OPHTE# /K- - 331 go Harnett County Department of Public Health 23345
PERMIT # 7. -t 8�`i � erp anon Per
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION:SCz2 rr5 Ce� /zb
Name: (owner) Z&C- `An— ='^' L SUBDIVISION QUt4-� 4-11 09' LOT # t P.
System Installer: '�-rr- s Registration #
Basement with plumbing: ❑ Garage Ymber of Bedrooms
Type of Water Supply: El Community LJ Public ❑ Well Distance from well feet
System Type: Za% iZft4lxlcr� 44-- r. 2 Types V VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact He Dep"ment 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules fo wage Treatment and Disposa and all conditions of the
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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.
Permit and Construction Authorization.
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other 2 5"7n t'G u z-st ! 3 Septic Tank: f Z 6b gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches -3 feet ditches _
French Drain Required: Linear feet
Authorized State,Aeent -- �' C--' / Date
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