OPHTE #—//, Harnett County Department of Public Health 24172
PERMIT # Zf569cf 0 eration P'etmit /
New Installation 4 Septic Tank 2 Nitrification Line O Repair ❑ Expansion
PROPERTY LOCATION;g[/55* s em, cef
Name: (owner) tZCM4 ,�,4—,., � oPe� SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Gd'Number of Be"Its .3
Type of Water Supply: ❑ Community LY Public Y Well Distance from well I CO a feet
System Type: Z M G21rt AJ Types V and VI Systems expire in S years.
(In accordance with Table Y a)n Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed id compliance eidh a0plir6lfe" CaAVa General Statutes. Rules for Smaee Treatment and Disposal. and all
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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afia snmrpermrnn in accaraance won nme .iyoi. S/L
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.
Construction Authorization.
❑ ID -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional ther 15%124&ytx-Ey-.— Septic Tank 1 d s U gallons Pump Tank: gallons
Subsurface No. of exact length_ width of depth of
Drainage Field ditches �of each ditch —75 feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Ag— Date —79
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16-5-37938 (1) 16-5-37938 (2) 16-5-37938 (3) 16-5-37938 (4) 16-5-37938 (5)
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16-5-37938 (6) 16-5-37938 (7) 16-5-37938 (8) 16-5-37938 (9) 16-5-37938 (10)
16-5-37938(11) 16-5-37938(12) 16-5-37938(13) 16-5-37938(14) 16-5-37938(15)
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16-5-37938 (16) 16-5-37938 (17)