OPHTE# / Harnett County Department of Public Health
PERMIT # Z& ,55'O Operation Perm- iitt a~ 2 2 2 5 5
M/New Installation 9 Septic Tank CZ` Nitrification Line ❑ Renair ❑ Exnansion
PROPERTY LOCATION• '11:5-1 j° C-1ji4 ee
Name: (owner) 5 SUBDIVISION ~°e s LOT #
System Installer: ~s ( Registration #
Basement with plumbing: ❑ Garage Vvumber of Bedrooms 3
Type of Water S ❑ Community M Public WTI Distance from well feet
System T r 3 Types V and VI Systems expire in 5 years.
(In accordant e V a) /F3 e~ s~caS ner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sew a Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
3-30 -12-
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10
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewaudispXrh-eA m on the above captioned property.
Type of system: El Conventional [/Other Septic Tank: /0,0 b gallons Pump Tank: 6t 6 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches ZZ - / inches
French Drain Required: Linear feet
1 ~
Authorized State A n Date
A
11-5-27861 (7) 11-5-27861 (8)
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b
11-5-27861(1) 11-5-27861 (2) 11-5-27861 (3) 11-5-27861 (4) 11-5-27861 (5)
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y z= "i ~ d f v a rya U' .
" n
.n •
11-5-27861 (6) 11-5-27861 (7) 11-5-27861 (8) 11-5-27861 (9) " 11-5-27861 (10)
11-5-27861(11) 11-5-27861(12) 11-5-27861(13) 11-5-27861(14) 11-5-27861(15)