OPHTE# 17 s '//0Z Harnett County Department of Public Health 24513
PERMIT # Z9370 ,9 eration Perm•
New Installation 13,1septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION
Name: (owner) ,d �-a-3 �c SUBDIVISION LOT #
System Installer. Da i/ Registration # X44 Au -e r, 1 Pow pc-.
Basement with plumbing: ❑ Garage /Number of Bedroon
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 2%i % Types V and VI Systems expire in 5 years.
(In accordance with Table V a) CZ Ow er must contact Health Department 6 months prior to expiration for permit renewal.
F
Ibis System has oven installed in romphance with applicable North Carolina Geneml Sutures, Rulu for Sewage Treatment and DisposaL and all wnditiom of the Improvement Permit and Construction Authonution.
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PERMIT CONDITIONS
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
specifications for the sewaWdisposal
system on the above captioned
property.
Type of system:
❑ Conventional Q' Other 7SA%Y
/7 %n c/C�T rr
Septic Tank: / U 4 _ gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches
exact length
of each ditch �C)
width of depth of
feet ditches 3 feet ditches J-7 — inches
french Drain Required: Linear feet
�7
Authorized State AgeDate Iy a 0 t
9
I
17-5-41021 (1)
17-5-41021 (2)
17-5-41021 (3)
17-541021 (4)
17-5-41021 (5)
'1
J
own
17-5-41021(6)
17-5-41021(7)
17-5-41021(8)
17-541021(9)
17-541021(10)
C,
17-5-41021 (11)
17-5-41021(12)
17-541021(13)
17-5-41021(14)
17-5-41021(15)
e
17-5-41021(16)
17-5-41021(17)
17-5-41021(18)
17-5-41021(19)
17-5-41021(20)
17-5-41021(21)