OPHTE# /6"5$$75' Harnett County Department of Public Health 24791
PERMIT # Z $$ /0eration Pe It
New Installation F27 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION s
Name: (owner) C —,rec— SUBDIVISION LOT #3t'
System Installer, S -4A — Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms 3
Type of Water Su If. ❑ Community �ublic F-1WellDistance from well feet
System Type: %7t' Types V and VI Systems expire in S years.
—
(In accordance with able V a) r must contact Health Department 6 months prior to expiration for permit renewal.
This system hu been installed in mm li a ¢pose, an ement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance:
11. Monitoring.
III. Maintenance:
IV. Operation:
V. Other.
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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 ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other Septic Tank: /000 gallons Pump Tank: I gallons
Subsurface No. of exact width of depth of
Drainage Field ditches _ of each ditch ) feet ditches 3 feet ditches 2 Y c inches
French Drain Reauired: Linear feet
Authorized State Agent',�. _ -5 /: �� �� Date Z `i — I i�
16-5-38879(12) 16.5-38879 (13) 16-5-38879 (14) 16-5-38879 (15) 16-5-38879 (16)
n
e
16-5-38879 (17) 16-5-38879 (18) 16-5-38879 (19) 16-5-38879 (20)
16-5-38879 (7)
16-5-38879 (8)
16-5-38879 (9)
16-5-38879 (10)
16-5-38879 (11)
16-5-38879(12) 16.5-38879 (13) 16-5-38879 (14) 16-5-38879 (15) 16-5-38879 (16)
n
e
16-5-38879 (17) 16-5-38879 (18) 16-5-38879 (19) 16-5-38879 (20)