OP RHTE# Harnett County Department of Public Health 23489
PERMIT # 7-75 80 ,0 ep ration PermitZ New Installation Q" Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Z
Name: (owner) GJs/lx. c4A'' a SUBDIVISION 4-*?.,.. � LOT # �Z
System Installer: 1,4,'c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: El Community Public El Well Distance from well feet
System Type: 51% cL)i jV C. — L pes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta Health Department 6 months prior to expiration or permit renewal.
This system has been installed in compliance with applicablel North Carolina General Statutes, Rules for
PERMIT CONDITIONS:
I. Performance:
ll. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
Treatment and Disposal, and all conditions of the
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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.
tsv 7,170,
and Construction Authorization.
0
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa a disposal system on the above captioned property.
Type of system: ❑ Conventional C Other ZZ126))Uc.n.t---<-,,51-ra,.,,. Septic Tank: iae a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 100' feet ditches 3 feet ditches Ld —)19 inches
French Drain Reouired: Linear feet
Authorized StateA e�ot____ : ---�'� �� (AAJAAYl ' Date
13-5-3212OR (11)
13-5-3212OR (10)
13-5-3212OR (9)
13-5-3212OR (8)
13-5-3212OR (7)
13-5-3212OR (6)
13-5-3212OR (5)
13-5-3212OR (4)
13-5-3212OR (1) 13-5-3212OR (13) 13-5-3212OR (12)
13-5-3212OR (3)
13-5-3212OR (2)