OPHTE#/ti ; 39-5`7 Harnett County Department of Public Health 24232
PERMIT # Z*B-Z% / 0 eratlon Permit /
Q Neww Installationc Tank 0 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONS /'BHT e—J tl Sly AZ6 _
Name: (owner) C A'%+ —2Rj SUBDIVISION CxmpLZ;,Jk IVI LOT # So
System Installer. Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: r4% 21'y , ,-§? G G .t . Type and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact H th Depai orient 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statuses, Rules for
I. Performance:
If. Monitoring:
111. Maintenance:
IV. Operation:
V. Other.
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ISI IoD
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and
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.
Permit and construction Authorintion.
❑ ID -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the se�waf� disposal system on the above captioned property.
Type of system: ❑ Conventional L�f Other 53%, .=VGrL6li ss 'fr,..— Septic Tank: D o a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ry✓ of each ditch U feet ditches 3 feet ditches rJinches
French Drain Recruited: Linear feet
Authorized StatDate 10 —5-
16-5-38797 (1)
16-5-38797 (6)
16-5-38797(2)
16-5-38797 (7)
16-5-38797 (3)
16-5-38797 (4) 16-5-38797 (5)
16-5-38797 (8)
16-5-38797 (9)