OPHTE#13 b —32ZoZ Harnett County Department of Public Health 2 4 0 ? 9
PERMIT # Z7S�(p 0 eration Permit 1
f New Installation Septic Tank LJ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATIOAN:�,/riuy dre,�S6,c
Name: (owner) i1'IzI 4— )x.,9,rs a �s SUBDIVISION /+✓�J�-� LOT #
System Installer: /Zo% i I Pti:se. s/ Registration #
Basement with plumbing:
El 4 umber of Bedrooms `%
Type of Water Supply: ❑ Community Ld Public ❑ Well Distance from well feet
System Type: '9?± T 6C=-e—I� Types V and VI Systems expire in S years.
(In accordance with Table V a) Ovidlacmd7AIAt Health Department 6 months prior to expiration for permit renewal.
This system has been installed in
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
nth Carolina General Statutes, Rules for Sewage Treasonous and
and all conditions of the Improvement Permit and
System shall perform in accordance with Rule .1961' sem'
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 sew a disposal system on the above captioned property.
Type of system:
❑ Conventional
Other ZS%
Septic Tank: ! 4) gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
tl of each ditch ?C feet
ditches 3 feet ditches Z7 inches
French Drain Recruited:
Linear feet
Authorized State sot C /� �` Date 3 - — — l6
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