OPPublic Health 2042
ATE# Harnett County Department of
PERMIT # Z 5"e�(. Operation Pe it /
El New Installation Septic Tank ❑ Repair Nitrification Line d Expansion
PROPERTY LOCATION:--�z z6c z, c-d, A V
Name: (owner) 10 rz.--s SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Be ooms
Type of Water Supply: ❑ Community LJ Public 10 Well Distance from well s o feet
System Type: Z5% 2X—bvz)i � shs T<2z -,PF (; 6 z9 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Tms system has peen installed In compliance wan apphcaole north carmma aeneraT matutes, ewes for sewage Treatment and
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and all conditions of me Improvement rerma and Lonstructton Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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:
Following are the specifications for the sewW disposal system on the above captioned property.
Type of system: ❑ Conventional 3 Other Z s to S.c s /i�,--- Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch /Za feet ditches 3 feet ditches Z'I 1 v inches
French Drain Required: Linear feet
Authorized State AQd-t %,� Date 1i — Z '�-- °7 "-
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