OPFITE# ZQ _r_ Z3`725 Harnett County Department of Public Health 2 0 91 8
PERMIT # Z"J a Operation Pent
New Installation lJ Se tic Tank El Re air Z Nitrification Line F-1 Expansion
P P PROPERTY LOCATION: /YjA lr,6
Name: (owner) 3Rr1 bit* G I+yr K) SUBDIVISION LOT #
System Installer: 76L-m , Co Registration #
Basement with plumbing. ❑ arage ❑ Number of Bedrooms 2
Type of Water Supply: ❑ Community ❑ Public Well Distance from well yo feet
System Type: 25-% RAL6~t ;;4 s i G !3-z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must con ct Health Department 6 months prior to expiration for permit renewal.
inn system nas Deen mstauea in compliance wim applicable North larolma beneral Statutes, Rules for Sewage Treatment and Disposal
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1. Performance:
11. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
following are the specifications for the seewwaa~isposal system on the above captioned property.
Type of system: ❑ Conventional 12 Other Z: Zft- ycrse-;~- Septic Tank: /yo D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch / z n feet ditches 3 feet ditches ZZ-~) /L inches
French Drain Required: Liinnear~feett
Authorized State A G r !/4'.~ Date
and all conditions of the Improvement Permit and Construction Authorization.
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