OP RRRHTE# P -5' Z776KXeo< Harnett County Department of Public Health 23338
PERMIT # Z(PZ7/ 3 � Ape ration P erinit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:. ]4.q Auoa o& ,C.D
Name: (owner) rj - — k�!'t1 SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 0"'Public ❑ Well Distance from well feet
System Type: P,-Q d$ ZV'"*X V and VI Systems expire in 5 years.
(In accordance with fable V a) Owner must contact He h Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
I. 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
❑ H2OLine ❑ PWR Line
Following are the
specifications for the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional L'Other y!!!
,ore 25'A /Z4f2U
Septic Tank: 16 n0 gallons Pump Tank: t O/i'6 gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches 2
of each ditch ! feet
ditches 3 feet ditches 2.19-318 inches
French Drain Required: Linear feet
Authorized State Agent 47'J 1,�g�-- r6 Date
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