OPHTE#jl's u~ Harnett County Department of Public Health
PERMIT # ZGa`~ Operation Flex I-t 22072
C2 New Installation A Septic Tank C2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1Lt3`7
Name: (owner) -5%~,vc-c,~ SUBDIVISION P-- l LOT # 3'7~
System Installer: Sr / fb Registration #
Basement with plumbing: ❑ Garage d Number of Bedrooms 3
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: G~&, Z kZ01 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewnydisposal system on the above captioned property.
Type of system: ❑ Conventional IJ Other Gas I S1 Septic Tank: 10 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches L of each ditch 15 b feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Date Its 7 1)
T
a
` m.
-
y
✓
11-5-26230 (1) 11-5-2623'; )
11-5-26230 (3) 11-5-26230 (4)
11-5-26230 (5)
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L
11-5-26230 (6) 11-5-26230 (7)
11-5-26230 (8) 11-5-26230 (9)
11-5-26230 (10)