OPHTE# /l9 _s—�� Harnett County Department of Public Health 24254
PERMIT # ZSS�S / w eration Pe nut /
r�' New Installation C� Septic Tank /Nitrification Line ❑ Repair L1 Expansion
PROPERTY LOCATION: ZC ,&S— /fb
Name: (owner) �w.,rlra,5 SUBDIVISION Cc sir>.,z L64.49c5 LOT #
System Installer: iflp-4- /bh+m 9s, r Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms j
Type of Water Supply: ❑Community L5A
A ublic ❑ Well Distance from well feet
System Type: T ISL i i Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must coAct Health Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable North Carolina General stations, Rules for Sewage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoritarian
PERMIT CONDITIONS
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 -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: El Conventional fJ+ Other ULCU Septic Tank /teay gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch 1Y6 feet ditches -3 feet ditches 74'sj1$ inches
French Drain Required: Linear feet
Authorized State enta�0i0F.L� Date -13--/6
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16-5-38604 (1) 16-5-38604 (2) 16-5-38604 (3) 16-5-38604 (4) 16-5-38604 (5)
ter 5 J`�` �•-.� �' � .. .: ' `�`\
16-5-38604 (6) 16-5-38604 (7) 16-5-38604 (8) 16-5-38604 (9) 16-5-38604 (10)
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16-5-38604 (11) 16-5-38604 (12) 16-5-38604 (13) 16-5-38604 (14) 16-5-38604 (15)
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16-5-38604 (16) 16-5-38604 (17) 16-5-38604 (18) 16-5-38604 (19) 16-5-38604 (20)
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16-5-38604 (21) 16-5-38604 (22) 16-5-38604 (23)