OP RHTE#o-i-s-/bS�j? Harnett County Department of Public Health 24509
PERMIT # Operation Per It
L ( New Installation c Tank C31/Nitrification line El Repair ❑ Expansion
PROPERTY LOCATIOM:S /S6s' arPwt it.es IZ6
Name: (owner) SUBDIVISION Z_11 :41e+t ��. s� a LOT # Jon
System Installer: _51-75,� c3u F4� Registration #
Basement with plumbing: ❑ Garage11umber of Bedrooms 3
Type of Water Supply: ❑ Community 13 Public ❑ Well Distance from well feet
System Type: T tQ � 'S 0ZL&4;Des 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 applicable North Carolina General Statute; Rules for Swage Treatment and Disposal, and all conditions of the Improvement eemnit and Contusion Authonudon
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
Other.
1
V
�1
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 ❑ H2OL1ne ❑ PWR Line
Following are the specifications for the sewage
disposal system on the above captioned property.
Type of system:
❑ Conventional 13" Other ZS�o�i��—i L —
Septic Tank 100 c�l` gallons Pump Tank gallons
Subsurface
No. ofexact
length
width of depth of
Drainage Field
ditches Z
of each ditch 1 SO feet
ditches feet ditches L7r7/0' inches
trench Dram Required: Linear feet
Authorized State Ag t� Date 'rS�, / 7
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