OP RRHTE#114—,5-oySg4e Harnett County Department of Public Health 24796
PERMIT # / 0 eration Permit
L1 New Installation Septic Tank L:`�' Nhitrification Line EJRepair ElExpansion
PROPERTY LOCATION:4/3ti5— �2Ca 's /4ca.a /9;6
Name: (owner) SUBDIVISION LOT # A0
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ =17A
ommum f ublic ElWell Distance from well feet
System Type: 1��/a rsr ! _ �,-r6 Types V and VI Systems expire in S years.
(In accordance with Table V a) < _ Own7er must contact Health Department 6 months prior to expiration for permit renewal.
L
I.Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑
Pump ❑
Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sewa a disposal
system on the captioned property.
Type of system: ❑
Conventional Other
�aaboove
� %L/45�+n
Septic Tank: gallons Pump Tank: zltc:�' gallons
Subsurface
Drainage Field
No. of
ditches
exact length
of each ditch 0O feet
width of
ditches 3
depth of
feet ditches inches
French Drain Required:
Linear feet
Authorized State A
t G.
y
Date
16-5-40456RR (1) 16-5-40456RR (2) 16-5-40456RR (3) 16-5-40456RR (4) 16-5-40456RR (5)
16-540456RR (6) 16-5-40456RR (7) 16-5-40456RR (8) 16-5-40456RR (9) 16-5-40456RR (10)
:7
16-5-40456RR (11) 16-540456RR (12) 16-5.40456RR (13) 16-540456RR (14) 16-5.40456RR (15)
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mom,
16-5-40456RR (16) 16-5-40456RR (17) 16-5-40456RR (18) 16-5-40456RR (19) 16-5-40456RR (20)
16-5-40456RR (21) 16-5-40456RR (22) 16-5-40456RR (23) 16-5-40456RR (24) 16-5-40456RR (25)
n"Now
16-5-40456RR (26) 16-5-40456RR (27) 16-5-40456RR (28) 16-5-40456RR (29) 16-540456RR (30)
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16-5-40456RR (31) 16-5-40456RR (32) 16-5-40456RR (33) 16-5-40456RR (34) 16-5-40456RR (35)