OP RRHTES
PERMIT # Z�llo2 3
Harnett County Department of Public Health
A eration Pewit
New Installation Y Septic
24259
Tank 2/Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIOIIW �ou
Name: (ovvner)A&m;a4#,.,, ,,5/6/j SUBDIVISION NTe7 _.S�s) .�� LOT # z
System Installer. �' C' t t- A Registration #
Basement with plumbing: ❑ Garage C�lumber of Bedrooms
Type of Water Supply:_ ❑Community LN Public ❑ Well Distance from well Net
System Type: Z, i Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner mu ontact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina Went Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoritanon
6 V
—�—r S c'c-a•� I
� D
PraM1T rnMnITInMO
I. Performance:
H. Monitoring:
III. 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 conditions, 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:
❑ Conventional Other /�f
Septic Tank:/%� o d gallons
Pump Tank: gallons
Subsurface
Drainage Field
No. of KAact lengib
ditches_ of each ditch % feet
width of
ditches feet
depth of
ditchesZg—OD inches
French Drain Required: Linear feet
Authorized State Age ! /���'r 'ZF Date /— ZC� '/ 7
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A
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