OP- can't sign off Brad has o/s fees shown for his dept. per J BrockNTE# -mss Harnett County Department of Public Health 24023
PERMIT # 28552 0 eration Permit
f3 New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION•;g/t-/Z -/s
Name: (owner) SUBDIVISION LOT # I
System Installer:1 a s /ria Registration #
Basement with plumbing: ❑ Garage /Humber of Bedrooms 3
Type of Water Supply: ❑ Community E� Public ❑ Well Distance from well feet
System Type: Sd sV and VI Systems expire in S years.
(In accordance with Table V a) t Owner must contact HeAth Department 6 months prior to expiration for permit renewal.
has been installed in compliance with applicable 116 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
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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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional d Other 1511, Septic Tank: /o0 o gallons Pump Tank: gallons
Subsurface No. of �g exact length width of depth of
Drainage Field ditches 1 of each ditch feet ditches 3 feet ditches Zy inches
French Drain Required: Linear feet
Authorized State AgeL(�Z .L,a t�J T � P Date
15-5-36965 (1) 15-5-36965 (2) 15-5-36965 (3) 15-5-36965 (4) 15-5-36965 (5)
15-5-36965(6) 15-5-36965 (7) 15-5.36965 (8) 15-5-36965 (9) 15-5-36965 (10)
15-5-36965 (11) 15-5-36965 (12) 15-5-36965 (13) 15-5-36965 (14) 15.5-36965 (15)
W-,4
15-5-36965(16) 15-5-36965(17) 15-5-36965(18) 15-5+ 36965 (19) 15-5-36965(20)
will
r
15-5-36965(21)