OPHTE#, s- 379-, r Harnett County Department of Public Health 24179
715'7 z
PERMIT # / Operation Per it
CTS/ New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONS /4a .Zattr,ca f4 -W R -D
Name: (owner) SUBDIVISION \4- LOT # L
System Installer: Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms
Type of Water Supply: ❑ Community �ublic ❑ Well Distance from well feet
System Type: S° t�I-G C2 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in mmoliance with aoolicable Nokh Carolina General Statutes. Rules for Sewage 'Treatment and Disoosal, and all conditions of the Imoroeement Permit and Construction Authoritarian.
I. Performance:
II. Monitoring:
If. Maintenance:
IV. Operation:
V. Other.
H
16
"X \$ /
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(1"..�s2�
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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sa disposal system on the above captioned property.
Type of system: El Co
Conventional Other icz Septic Tank: too e> gallons Pump Tank: gallons
Subsurface No. of exact agth width of depth of
Drainage Field ditches 3 of each ditch 100 feet ditches feet ditches LN inches
French Drain Reclined: Linear feet
Authorized State e—� � Date ` 1 � O —
16-5-37971 (1)
16-5-37971 (2)
16-5-37971 (3)
16-5-37971 (4)
16-5-37971 (5)
16-5-37971 (6)
16-5-37971 (7)
16-5-37971 (11) 16-5-37971(12)
16-5-37971 (8)
16-5-37971 (9)
16-5-37971 (10)