OPHTE# JIo S_ 3�'2/1� Harnett County Department of Public Health 24397
PERMIT # Z) :S'Y Operation Per It
E New Installation Septic Tank Eir Nitrification line ❑ Repair 2 Expansion
PROPERTY LOCATIONUai /y47 Cdy&! A,q db r -1 -4k -A.
Name: (owner) 7jy 'f- SUBDIVISION ULOT #
System Installer:. L;4 , 4'6 Ca� Registration #
Basement with plumbing: ❑ Garage ❑/ Number of Bedrooms 3
Type of Water Supply: ❑ Community Q Public jKWell Distance from well 166 i feet
System Type: 2.9% IZ-41x. A 1 " Own� T C T es V and VI Systems expire in 5 years.
(In accordance with Table V a) er must contact Health 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
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I
System shalllperform 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 ❑
M20Line ❑
PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional IV Other ZS'�oR/-2cb0C,M Septic Tank: 10 0 6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ) of each ditch 2-00 feet ditches -3 feet ditches 22--518 inches
French Drain Required: Linear feet
Authorized State Ager s 2 / te4.4'Z� K Date j - Z/ -/ 7
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16-5-39215 (1) 16-5-39215 (2) 16-5-39215 (3) 16-5-39215 (4) 16-5-39215 (5)
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16-5-39215(6) 16-5-39215(7) 16-5-39215 (8) 16-5-39215 (9) 16-5-39215(10)
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16-5-39215 (11) 16-5-39215(12) 16-5-39215(13) 16-5-39215(14) ` 16-6-39215(15)
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16-5-39215(16) 16-5-39215(17) 16-5-39215(18) 16-5-39215(19) 16-5-39215(20)
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16-5-39215(21) 16-5-39215(22) 16-5-39215(23)