OP RHTE# 16-5-40-45x2 Harnett County Department of Public Health
24381
PERMIT # 2"31 z 0eration Per it
LTJ New Installation Septic Tank L4' Nitrification Line ❑ Re air El Expansion
PROPERTY LOCATION: S�e��� ccr� �51Z IEf�
Name: (owner) N -nn;<, lac -'j 6kckrltna SUBDIVISION LOT #
System Installer: -i Registration #
Basement with plumbing: ❑ Garage El other of Bedrooms 3
Type of Water Supply: ❑ Community l Public ❑ Well Distance from well feet
System Type: 25%a oc>< o Types V and A 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 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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I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
III. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Limf ❑ PWR Line
Following are the specifications for the sewage disposal system on the above caEtioned property.
Type of system: ❑ Conventional ❑ Other Septic Tank: U gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch U feet ditches ; feet ditches inches
trench Drain Required: Linear feet
Authorized State Ag��f? t ( ,an �'` � 5 Date 7-- 1 - l7
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16-540257R (1) 16-5-40257R (2) 16-5-40257R (3) 16-5-40257R (4) 16-540257R (5)
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16-540257R (6) 16-540257R (7) 16-5.40257R (8) 16-540257R (9) 16-5-40257R (10)
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16-540257R (11) 16-5-40257R (12) 16-540257R (13) 16-540257R (14) 16-540257R (15)
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16-540257R (16) 16-5-40257R (17) 16-540257R (18) 16-540257R (19)