OPHTE#(o– J�3�1�1 /n S Harnett County Department of Public Health 24352
PERMIT # Z g o 9 3 / Operation Pe It
d New Installation ff Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONkVj-73S' 1(oe/ Gl.-rl'.[.GG( "Z/)
Name: (owner) s,TI-L- a- /3/t2- SUBDIVISION LOT # S�
System Installer: Registration #
Basement with plumbing: ❑ Garage —lumber of Bedrooms 3
Type of Water Su ply: ❑ Community I3 Public ❑ Well Distance from well feet
System Type: 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.
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[his system has been installed in compliance with applicable North Carolina General Statutes, Rules for Se Treatment and Disposal, and all conditions of the Improvement Permit and construction Audiomation
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PERMIT CONDITIONS:)'"'0CJ
I. Performance:
H. 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 ❑ 112O1-ine ❑ PWR Line
Following are the specifications for the sew3ga disposal system on the above captioned property.
Type of system: ❑ Conventional Cv7 Other 750/6 rLG= i J> JC—tr(TJ Sves412-- Septic Tank: /000 gallons Pump Tank: G O gallons
Subsurface No. of exact length width of depth of t
Drainage Field ditches of each ditch / Z D feet ditches feet ditches inches
French Drain Reouired: Linear feet
Authorized State A nt [V�K-fi '—' Date Z —22
ownd
swim I
16-5-39968 (1) 16-5-39968 (2) 16-5-39968 (3) 16-5-39968 (4) 16-5-39968 (5)
16-5-39968 (6) 16-5-39968 (7) 16-5-39968 (8) 16-5-39968 (9) 16-5-39968 (10)
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r: Mh.,— , by
15-5-39968 (16) 16-5-39968 (17) 16-5-39968 (18) 16-5-39968 (19) 16-5-39968 (20)
16-5-39968 (21) 16-5-39968 (22)