OPNTE# ) 4 -5 - M6 1C Harnett County Department of Public Health 24685
PERMIT # ZYIu QDeration Permit. „tom; o ly
New Installation Septic Tank itrification Line ❑ Repair ❑Expansion
PROPERTY LOCATION: 2414 C krs ---,&A L.ymt AA i s.n iv
Name: (owner) Esenej4. --T. 6a.cx,svt SUBDIVISION LOT #
System Installer.CII a t Registration #
Basement with plumbing: ❑DGarage Number of Bedrooms
Type of Water Supply: ❑ Community L�-Frublic ❑ Well Distance from well feet
System Type: Gc,,.,,. r r Det (cx-r) X Z6io nLd s rs —r7= Types V and VI 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 applitxble North Carolina General Smmtm Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consortium Audmrintion
rurni LUNUIIIUMS:
I. Performance:
11. Monitoring:
111. 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 specific ' for the sewage disposal system on the above captioned toe
Type of system: Conventional Gk"6ther EZ GLo J Septic Tank: i i gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a t.at,,� of each ditch 50 feet ditches feet ditches orf° '%% inches
bench Drain Required: Linear feet
Authorized State AgentDate`�" O$ J 0014-
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rurni LUNUIIIUMS:
I. Performance:
11. Monitoring:
111. 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 specific ' for the sewage disposal system on the above captioned toe
Type of system: Conventional Gk"6ther EZ GLo J Septic Tank: i i gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches a t.at,,� of each ditch 50 feet ditches feet ditches orf° '%% inches
bench Drain Required: Linear feet
Authorized State AgentDate`�" O$ J 0014-
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