OPHTE# )9- S ----3S0-7 I Harnett County Department of Public Health
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PERMIT # 262-1 0 ep ration Permit
New Installation E� Septic Tank . Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1W
Name: (owner) :)22�r�/ iyzlt ,S r rc SUBDIVISION _(v � i�j'" LOT #
System Installer: ria - Registration #
Basement with plumbing: ❑ Garagembar of Bedrooms -
Type of Water Supply: ElCommunity Public ❑ Well Distance from well feet
System Type: 2 r Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must co act Health Department 6 months prior to expiration for permit renewal.
This system has been installed in
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
111. Maintenance:
IV. Operation:
with applicable North Carolina Genera tatutes, Rules for Sewage Treatment and Disposal, and all conditions of the
;I L
(,j f t—
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.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Y Other W>lo ZO)UCTZ6,.- L Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 160 feet ditches -� feet ditches —Z- q inches
French Drain Required: Linear feet
Authorized State Ag t Date �� `�
14-5-35071 (1)
14-5-35071 (2)
14-5-35071 (3)
14-5-35071 (4)
14-5-35071 (5)
14-5-35071 (6)
14-5-35071 (7)
14-5-35071 (11) 14-5-35071 (12)
14-5-35071 (8)
14-5-35071 (9)
14-5-35071 (10)