OPHTE# IL, -5---3M -7,1 Harnett County Department of Public Health 24347
PERMIT # 0 eratlon Pe It
New Installation Septic Tank E� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION;�ir (q1A f2T)
Name: (owner) �a t I Iii lf=a�sht, r2 Zr_ SUBDIVISION LOT # l
System Installer: —%i , !.J Registration #
Basement with plumbing: ❑ Garage (lumber of Bedrooms
Type of Water Supply: ❑ Community Ik' Public ❑ Well Distance from well feet
System Type: Z5'6/e 2G tw 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.
This system has been imtalled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all candmons of the Improvement Permit and Cowncdun Amhomation.
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 ❑ 111201-ine ❑ PWR Line
Following are the specifications for the se—wa$a disposal Ttem on the above captioned property.
Type of system: El Conventional L� Other 2-0 '7v %-Zu Lc;-ko- =,s�-— Septic Tank 100 U gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch r 0 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State AgeD"t 1 �---� /" � k--�� Date L - 9—i
16-5-39771 (1)
16-5-39771 (6)
16-5-39771 (2)
16-5-39771 (7)
16-5-39771(3)
16-5-39771 (8)
16-5-39771 (11) 16-5-39771 (12) 16-5-39771 (13)
16-5-39771 (4)
0 4i6 4-114,m
, t
16-5-39771 (9)
16-5-39771 (5)
16-5-39771 (10)