OP RHTE# Harnett County Department of Public Health 24189
PERMIT # Z$e63Z 0 eratlon Permit /
3 New Installationc Tank L� Nitrification Line ❑ Repair ❑ Expansior
�n PROPERTY LOCATION: ntusZos— O t st� 13.,r," exeap 4b
Name: (owner) K*o f ./3Jllr Aor1c�� SUBDIVISION S 4+ tiQ, )'t LOT #
System Installer: � 16:� d✓ .(2 tQ2�.. Registration #
Basement with plumbing: ❑ Aarage 4Number of Bedrooms 3
Type of Water Supply: ❑ Community Q� Public ❑ Well Distance from well feet
System Type: ti¢ G EZ� Types V and VI Systems expire in S years.
(In accordance with Table V a) --f Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statures, Rules for Synge Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewag�,disposal system on the above captioned property.
Type of system: ❑ Conventional Y Other 25%' t7-FbUC f—f" Septic Tank: f Oy a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch 8� feet ditches 3 feet ditches Zy X18 inches
trench Drain Required: linear feet
Authorized State Age` �/r— Date ("�
16-5-38256R (1)
16-5-38256R (2)
16-5-38256R (3)
16-5-38256R (6)
16-5-38256R (7)
16-538256R (8)
16-5-38256R (4)
16-5-38256R (9)
16-5-38256R (5)
16-5-38256R (10)