OP R59c i1-5-441 24989
NTE# Harnett County Department of Public Health
PERMIT # Daration Perm' �
New Installation RISeptic Tank 2 --Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: tin G Sur 52 1-56�
Name: (owner) T ?--I e Aon SUBDIVISION LUl IF
System Installer. Cr.c zs Registration # adds
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public ell Distance from well ISa feet
System Type: 5Types V and VI Systems expire in S years.
(In accordance with Table V a) ner must contact Health Department 6 months prior to expiration for permit renewal.
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961. /
111. 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:
c?S$ RE�c. ci o,J
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage system on the above captioned p
El
Type of system: Conventional Other 1 Cl fl -z> Septic Tank: IdCY 3 gallons Pump Tank:gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches /(9 inches
French Drain Required: Linear feet P
Authorized State Date