OP RRHTE# Ib- s-3" 32Q Harnett County Department of Public Health 24348
PERMIT # a Z ? O g37i— Deration Permit /
Eir New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /��/w/o__.Q/�
Name: (owner) �•tu��c/c�u� SUBDIVISION LOT # /
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrms
Type of Water Supply: ❑ Community El Public Ism" Well Distance from well T0 v i feet
System Type: 0s% TL, G ! 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:
11. 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 sewaf� disposal system on the above captioned property.
Type of system: ElConventional Cd" Other ZV%,XE1�tX?kit__ Septic Tank: /64 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 10 O feet ditches 3 feet ditches Z Z— nches
French Drain Required: Linear feet
Authorized State Age G� Date _ S — /o—(�
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4
16-5-38793RR (1) 16-5-38793RR (2) 16-5-38793RR (3) 16-5-38793RR (4) 16-5-38793RR (5)
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1
16-5-38793RR (11) 16-5-38793RR (12) 16-5-38793RR (13) 16-5-38793RR (14) 16-5-38793RR (15)
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16.5.38793RR (16) 16-5-38793RR (17) 16-5-38793RR (18) 16-5-38793RR (19)