OPNTE#/(,'1' 3SZoC Harnett County Department of Public Health 24355
PERMIT # 2505 3 0 eratlon Per it /
D' New Installation Septic Tank l�J Nitrification Line ❑ Repair ❑ Expansion
(owner)
n pp ����� PROPERTY LOfATION:3i! /y, .1 �'�6(c,it iZ/P>
Name: owner v /c�r.--G/7e"'-�—= Tom?- SUBDIVISION 7i-�,cc� LOT # /6
System Installer: //F's) ZJ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms �f_
Type of Water Supply: ❑ Community �� ❑� Public El Well Distance from well feet
System Type: 1 g8At: T �f J L� Tv (! � types V and VI Systems expire in 5 years.
(In accordance with Table V a) I Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been nutalled in compliance with applicable North Carolina G{neral Staryles, Rules for Sewage Treatment and Disposal, and all—c—o—nd—ii—io—n—s—o(--the—l—mp—m—y—effinrfertnitand Lonsmction Authoritarian.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑
z~ -
H2O1.ine ❑
Following are the specifications for the seewwo disposal system on the above captioned property.
Type of system: ❑ Conventional f3 Other Ltsr% r14fX orGa-- Septic Tank: S—a gallons Pump Tank
Subsurface No. of exact length width of depth of
Drainage Field ditches L/ of each ditch L) feet ditches 3 feet ditches
French Drain Required: Linear feet
Authorized State Age t Date L- 2'1 -1-7
PWR Line
gallons
78" 2 15 inches
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16-5-39209 (6)
16-5-39209 (2)
16-5-39209 (3)
U�1.._ -
16-5-39209 (4)
16-5-39209 (5)
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16-5-39209 (7) 16-5-39209 (8) 16-5-39209 (9) 16-5-39209 (10)