OPHTE# "'-1 -s - 18F « Harnett County Department of Public Health 19608
PERMIT # ' 3 l Operation Per it
1' New Installation Se tic Tank ❑ Repair 2"'Nitnfication line ❑ Expansion
PROPERTY LOCATION:_
Name: (owner) A W 'Zj "41 k'.3 j SUBDIVISION LOT #
System Installer. ukA-,, s f~r: t kl '-A Registration # / 4 z
Basement with plumbing ❑ Garage ❑ Number of Bedrooms 44
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well _ feet
System Type: 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.
MIS system nu been mstaled in compliance with applicable Math tarokna General ftatuta, Kula for Sewage Treatment and Disposal and aM cord dmn of the mlrovement Permit and eomtnKrioa Audwrindon. 7~
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PRMIT f MrimoNt.
1. Performance:
If. 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 ❑
N yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewa disposalsystem on the above captioned property.
Type of system: ❑ conventional Elf Otherz-ifl, '-.4 Size of tank: Septic Tank: f 03 Cj gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch L U feet ditches 3 feet ditches _1$inches
French Drain Required: linear feet
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Authorized State Agen..
Date