OPHTE# 1�_S-3g X91
Harnett
County Department of Public Health
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PERMIT # r
,4 eration Per
24374
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New Installation Septic Tank CRS Nitrification Line
❑ Repair ❑ Expansion
PROPERTY LOCATION: 4 6 fzca
Name: (owner) ���wS 6aVs
8idy. (.Q.
SUBDIVISION_A�l� 10;)(a��
LOT# LV
System Installer. C" 0 3 MQ
v
Registration #
Basement with plumbing: ❑ Garage 5KN11mber of Bedrooms
Type of Water Supply: ❑ CommunityPublic
❑ Well Distance from well 66 feet C Nc jR1o)
System Type: 2 ' .-c&
S 7 SFr-,
Types V and VI Systems expire in 5 years.
(In accordance with Table V a)
Ow r must contact Health Department 6 months prior to expiration for permit renewal.
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No f'T
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage sal system on the above captioned property.
Type of system: ❑ Conventional Other r5� �oci;ot` Ez Z=kG" Septic Tank: ���`-' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field - of each ditch y00 feet ditches
ui —Z feet ditches Z� inches
French Drain Re
q d6>h� linear feet
Authorized State Agent ��
8 M Date 1 3117
v.6-5-��1$�