OPHTE# ( - -- R 44 Harnett County Department of Public Health 2 4 3 8 6
PERMIT# ZG95 5 Aeration Permit
NKNew Installation peptic Tank 12rl—trification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: bxeQrA- itis. 65 b;: (c!d Sl4m gj -s2-fcz\
Name: (owner) c SUBDIVISION U,cC;rA k,:,c es LOT # J
System Installer: 0: rt k k6*ms Registration #
Basement with plumbing: ❑ Garage NyNdrfr of Bedrooms —')
Type of Water Supply: ❑ Community Public ❑ Well Distance from well s c:n `' feet
System Type: 'Z1 Types V and VI Systems expire in 5 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 comoliana with aooliable North Carolina G.n.nl snnm. R.J. rn. s...,.. T..,em... ,ne Me n! ..a ,u —.a,.— .1 .1 . i_.....-_... .._:..- __
�mm wnsnnons
I. Performance:
II. 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 ❑
H2OLine ❑
PWR Line
Following are the
_. r-_.• __
... _.......... .. .... ....e............ �.�...�. ... .,.�,,...n.n ..nnn�...�.n.
i Qvrn,V Tony j..,sC.ct4; en
/t^• ill I ��
zse r.,, 451
8p Cad~�17 m
Type of system:
in
e5
[9' Other z6/ 14 —ssA L`7 r1c,
lit
!�
t�
$ I�
3tTrc
ZZ I'
exact length
SF6�
Drainage Field
ditches
°tom
ditches '3 feet ditches 3G inches
tl� l
�mm wnsnnons
I. Performance:
II. 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 ❑
H2OLine ❑
PWR Line
Following are the
specifications for
the sewage 490ssal system on the above captioned property.
Type of system:
❑ Conventional
[9' Other z6/ 14 —ssA L`7 r1c,
Septic Tank /0 L gallons Pump Tank 4�G6 gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
-3 of each ditch c4U feet
ditches '3 feet ditches 3G inches
French Drain Required: Linear feet
[Authorized State Agent Date p5�p 2 zo t
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