OP RHarnett County Department of Public Health 24024
PERMIT # Z`d fiS Operation Pe,milt
ElNew Installation 19' Septic Tank IZ Nitrification line ❑ Repair E2 Expansion
PROPERTY LOCATION:c3 100t 4+D rzp
Name: (owner) Arsee-i.— ✓OhLi)� SUBDIVISION LOT #
System Installer: _ L9 tw S Registration #
Basement with plumbing: ❑ J Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community C/ Public f�_Well Distance from well ic6 f" feet
System Type: ?5 °l R' 7 u L2ot ±a ! C9•,-rIpusY 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.
This system has been installed in compliance with appsliablee Harth Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all considers of the Improvement Permit and tnnstrucuon Authontauon.
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PERMIT CONDITIONS
I. Performance:
If. Monitoring:
111. 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 condisions, maintenance and reporting.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
following are the
specifications for
the sewa disposal system on the above captioned property.
Type of system:
ElConventional
7Other Z� Z Rev crzo— Septic Tank: /trarc
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
y of each ditch Lao feet ditches 3
feet ditches t2 inches
French Drain Required: Linear feet �J
Authorized State Agefit—� j /�( Date $ ��
15-5-36775R (1)
15-5-36775R (2)
15-5-36775R (3)
15-5-36775R (4)
15-5-36775R (5)
15-5-36775R (6)
15-5-36775R (11)
15-5-36775R (7)
15-5-36775R (8)
15-5-36775R (9)
15-5-36775R (10)