OP - Can't sign off in HTE.NTE# .s-3���z Harnett County Department of Public Health 24191
PERMIT # 2 PC, 13 / 0 eration Per t�
EY New Installation d Septic Tank L1 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Z,( -/SS / Ayj r� Icy
Name: (owner) SUBDIVISION LOT #
System Installer: /11kL Aegistr tion #
Basement with plumbing: ❑ Garage ❑ Number of B Jrooms _� 5 1-7
Type of Water Supply: ❑ Construing 0 Public Ff Well Distance fro well �'y feet
System Type: 7 ('tiA -Y-z,, IS- Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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I. Performance:
II. 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.
❑ D -Boz ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of t,t exact length
Drainage Field ditches I of each ditch 9.ZS� feet
Alarm ❑ H2OLine ❑ PWR Line
1
Septic Tank: J= gallons Pump Tank: 7—$60 gallons
width of depth of
ditches feet ditches Zinches
French Drain Required: Linear feet
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Date 2 'Z6 -
Authorized State /G
16-5-37892 (1) 16-5-37892 (2) 16-5-37892 (3) 16-5-37892 (4) 16-5-37892 (5)
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16-5-37892 (6) 16-5-37892 (7) 16-5-37892 (8) 16-5-37892 (9) 16-5-37892 (10)
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16-5-37892(11) 16-5-37892(12) 16-5-37892(13) 16-5-37892(14) 16-5-37892(15)
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16-5-37892(16) 16-5-37892(17) 16-537892(18) 16-5-37892(19) 16-5-37892(20)
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16-5-37892 (21) 16-5-37892 (22) 16-5-37892(23) 16-5-37892(24) 16-5-37892(25)
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