OPHTE# `z-' - 2-849 Harnett County Department of Public Health
PERMIT # "Installation Pe >mit 2 2 2 9 6
L~J New Installation Septic Tank 2/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:Xd-1463
Name: (owner) 5 Cam/ 47ur- ~-a SUBDIVISION t'a to LOT # `
System Installer: 3 Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community ICI Public ❑ Well Distance from well feet
System Type: FL-p 4D Types V and VI Systems expire in 5 years.
(In accordance with able V a) Owner c ntact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z`5'%Zgb -Q s Septic Tank: Jg))Q6 gallons Pump Tank: 1006 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 7-70 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Ag nt Date' `
F
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b.
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12-5-28169 (1)
12-5-28169 (2)
12-5-28169 (3) 12-5-28169 (4)
12-5-28169 (5)
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12-5-28169 (6)
12-5-28169 (7)
12-5-28169 (8) 12-5-28169 (9)
12-5-28169 (10)
a~aa y
. 1
12-5-28169 (11)
12-5-28169 (12)
12-5-28169 (13)