OPHTE# //-/ - r -532o0 Harnett County Department of Public Health 23501
PERMIT # Z� `d�� / Operation PermitCY New Installation EPeSeptic Tank [Z Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIMN /q -n /LZ
Name: (owner)Si/ f�UTi/t�2` -7 SUBDIVISION LOT # 21
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Rr Public ❑ Well Distance from well feet
System Type: jy 2 .zr--G' .!'2 (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 Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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DGDMIT rn AInITIMIC•
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
❑ 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 Other Zs°/n Septic Tank: /6 6,D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Ll of each ditch feet ditches 3 feet ditches 2—q)I 9 inches
French Drain Required: _ _ _ Linear feet
Authorized State ARegf - - — 7 — r j� Date
14-5-33200 (1)
14-5-33200 (2)
14-5-33200 (3)
14-5-33200 (4)
14-5-33200 (5)
14-5-33200(6)
14-5-33200 (7)
14-5-33200 (8)
14-5-33200 (9)
14-5-33200 (11)
14-5-33200(12)
14-5-33200 (13)
14-5-33200 (14)
14-5-33200 (10)