OPHTE# IS—S-3"7130 Harnett County Department of Public Health 23884
PERMIT # Z?.SS(o 0 eratlon Permit
M/New Installation Z Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOLATION;�r/y Z� 4
Name: (owner) �Irrui SUBDIVISION L/&--5/i3xh 6 .o LOT # S9
System Installer. Registration #
Basement with plumbing: ❑ Garage ember of Bedrooms 3
Type of Water Supply: ❑ Community Lel Public ❑ Well Distance from well feet
System Type:1.5a/� (L�'sf) u U,Z,✓TJ 5,�� Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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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 Lonstrumon Authomanon.
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PERMIT CONDITIONS:
I. Performance:
If. Monitoring:
III. Maintenance:
IV, Operation:
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 25 % aZE krie-� Septic Tank: / n0 D gallons Pump Tank: gallons
Subsurface No. ofexact length width of depth of
Drainage Field ditches of each ditch 34oD feet ditches 3 feet ditches 19—ZO inches
trench Oram Required: Linear feet
Authorized StateAg V/fi0 1 f�'� Date
15-5-37130 (1) 15-5-37130 (2)
15-5-37130 (3) 15-5-37130 (4) 15-5-37130 (5)
15-5-37130 (6)
15-5-37130 (11)
15-5-37130 (16)
15-5-37130 (7)
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3♦J ,.
15-5-37130 (12)
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15-5-37130 (6) 15-5-37130 (9) 15-5-37130 (10)
15-5-37130 (13) 15-5-37130 (14) 15-5-37130 (15)