OP RHTE# ;L—t 3_l9Z Harnett County Department of Public Health
24479
PERMIT /Operation Per It
Fv( New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: :5-01 da 0S
Name: (owner) 4FduC. 10oo.V-4,11 SUBDIVISION LOT # I
System Installer: Sati. rk,.� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Borooms (n �
Type of Water Supply. ❑Q ,C,�ommuni•ty_ ❑ Public f3 Well Distance from well 106t feet
System Type: mLaC�__ gCd,!fkeZ Types V and A Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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 -Boz ❑ Pump ❑ Alarm ❑ 111 ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Y Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches 2 of each ditch /010 feet
Septic Tank: I DOy gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 2 4—? I $ inches
French Drain Required: Linear feet
Authorized Stat gent Date
15-5-37419R (1)
15-5-37419R (2)
15-5-37419R (3)
15-5-37419R (4)
15-5-37419R (5)
15-5-37419R (6)
15-5-37419R (11)
15-5-37419R (7)
Ak.
4 j �
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Auk
15-5-37419R (12)
15-5-37419R (8)
15-5-37419R (9)
15.5-37419R (10)