OPHTE#/S-S 3s704 Harnett County Department of Public Health Jo 23604
PERMIT # Z 9_5 , Operation Permit 1
E New Installation Septic Tank E l Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:Aej-7oo rx-4 t I ✓LA
Name: (owner) %�;� /°�c%s ,� SUBDIVISION /It4,, 14e 11 LOT # J3
System Installer: .57'/3os Registration #
Basement with plumbing: ❑ Garage Vpuublic
mber of Bedrooms 3
Type of Water Supply: El Community ❑ Well Distance from well feet
System Type: go LTypes V and VI Systems expire in 5 years.
(In accordance with Table V a) P Owner must ontact 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
rtKMI! U/NUIIIUNS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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51Z 1700
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 ❑
Following are the specifications for the seewws�tsposal system on the above captioned property.
Type of system: Elional ConventLet Other Zz°% Ak'6v0—e._
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
French Drain Required: Linear feet
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: / y On gallons Pump Tank: gallons
width of depth of
ditches feet ditches 12,'VE inches
Authorized State Age — O " (/ %-oma —� Date 4, / 1
15-5-35906 (1)
15-5-35906 (2)
15-5-35906 (3)
15-5-35906 (4)
15-5-35906 (5)
15-5-35906 (6)
15-5-35906 (7)
15-5-35906 (11) 15-5-35906 (12)
15-5-35906 (8)
15-5-35906 (9)
15-5-35906 (10)