OPHTE# b$ --5-` 01321 Harnett County Department of Public Health 2 0 4 4 8
PERMIT # ZSUS Operation- Pe it
5(NeW Installation V Septic Tank ❑ Repair dNitrification Line ❑ Expansion
PROPERTY LOCATION:,5;/y/6w ~o
Name: (owner) G SUBDIVISION ,a.-/ LOT # /4
System Installer. T66- fps Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms -3
Type of Water Supply: ❑ Community EJ Public ❑ Well Distance from well feet
System Type: Zb r2~ ~/A,-. 7-V .71V G Z-0 IA7 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewa con itions o Improvement Permit and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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 sew We disposal system on the above captioped prof
Type of system: ❑ Conventional Other 25°1a(Z1''At~cf2.f-l 7re ll d Septic Tank: 10() D_ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches Z of each ditch 1 SLl feet ditches feet ditches 21 -)19 inches
french Drain Required: Linear feet
Authorized State A n ~2t~t,~, G / "~i},r//, ~rrl f Date `7- l L-t9q
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