OPHTE#16—S-3F2Y Harnett County Department of Public Health 24199
PERMIT # ZbSGZ Operation Pe it
New Installation Septic Tank d Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION;OCI Ir d 11*�W AW
Name: (owner) 440A� Av._1-1- SUBDIVISION — A42h._Z,,.6, P.,— a LOT # _
System Installer. A Registration #
Basement with plumbing: ❑ Garage .
G2�umber of Bedrooms _
Type of Water Supply: El Community 03' Public ❑ Well Distance from well feet
System Type: ZSloTZG"UGa > G ner mut/t Types V and VI Systems expire in S years.
(In accordance with Table V a) Ow st ntact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoruadon
PLNMII CUNOIIIUN6:
I. Performance:
11. 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 -Box ❑ Pump ❑ Alarm ❑ _
following are the specifications for the sews a disposallsslstem on the above captioned property.
Type of system: El Con 70ther a" G Fz U°� Septic Tank:
Subsurface No. of exact lengthr width of
Drainage Field ditches 3 of each ditch feet ditches -
H2OLine ❑ PWR Line
Joe) O gallons Pump Tank: gallons
depth of
3 feet ditches a inches
French Drain Required: Linear feet
Authorized State Ag A,✓ Date 9-4— 1
16-5-38564 (1)
16-5-38564 (2)
16-5-38564 (3)
16-5-38564 (4) 16-5-38564 (5)
16-5-38564 (6)
16-5-38564 (7)
16-5-38564 (8)
16-5-38564 (9)