OP RHTE# tc.--� �2 Harnett County,,Department of Public Health 24253
PERMIT # 2495 0--) 0 eration Pe It
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION
Name: (owner) (Z� 11nne, tICSUBDIVISION LOT # L4—
System Installer. _ QA1Xz TA.1 Registration #
Basement with plumbing: ❑ Garage ember of Bedrooms 3
Type of Water ❑ Communi LC( Public El Well Distance from well feet
System Type: I- n 1'- Types V and VI Systems expire in S years.
(In accordance with Table V a) V Owner m ealth Department 6 months prior to expiration for permit renewal.
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This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage 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.
IL Monitoring: As required by Rule .1961.
111. 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.
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Cl D -Box ❑ Pump ❑ Alarm ❑ 112OLine
Following are the specifications for the seewdisposal sys on the ov wptigned property.
Type of system: ❑ Conventional Other ,T Septic Tank: G6 D gallons
Subsurface No of exact length width of
Drainage Field ditclle of each ditch feet ditches feet
French Drain Required:, near feet
Authorized State Agent ---li � RGNS Date
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0
PWR Line
Pump Tank: 0iC) gallons
depth of/Q n
ditches � inches
S
16-5-38100 (1) 16-5-38100 (2) 16-5-38100 (3) 16-5-38100 (4) 16-5-38100 (5)
16-5-38100 (6) 16-5-38100 (7) 16-5-38100 (8) 16-5-38100 (9) 16-5-38100 (10)
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ZAMA.I
16-5-38100 (11) 16-5-38100 (12) 16-5-38100 (13) 16-5-38100 (14) 16-5-38100 (15)
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16-5-38100 (16) 16-5-38100 (17) 16-5-38100 (18) 16-5-38100 (19) 16-5-38100 (20)
16-5-38100 (21) 16.5.38100 (22) I�
II