OPHTE# 11-6-11504- Harnett County Department of Public Health 24931
PERMIT # d9 a ration Perm ��
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: -20—f
Name: (owner)"' n C-0 66 -i SUBDIVISION �uFc
System Installer: lnc�x-{cans P�r,rb; n•, Registration #
Basement with plumbing: ❑ Garage Q u�ef Bedrooms
Type of Water Supply: El Community 9 -Public ❑ Well Distance from well ► >/k feet
System Type: 2. 5, s•LeM, Systems
(In accordance with Table Y a) IOwner must <ontact`Health Depa tment
This system has been installed in comDliance with anuliable Noah Carolina General Statutes. Rules for
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
d
'D Ins'
utati 5�;,
POW.kI
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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.
e in S years.
prior to expiration for permit renewal.
of the Improvement Permit and Construction Authorization.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLme ❑ PWR Line
Following are the
specifications for
the sewage d system on the above captioned property.
Type of system:
El
ther �:7— 1=Aov1.. ti
Septic Tank gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
R L
Drainage field
ditches
of each ditch inU feet
ditches feet ditches inches
french Drain Required: linear feet
Authorized State Agent / Date C)3/%63/R—J �t'