OPHTE# I G - s - - �9p4 Harnett County Department of Public Health 24385
PERMIT # 1 U46 Operation Perm'
C+f' New Installation Septic Tank {Nitrification Line ❑ Repair ❑ Expansior
41pe"C-t4 r-4,8 Comm rv. PROPERTY LOCATION: OS 42-1 ry.
Name: (owner) D can Sloan) SUBDIVISION LOT #
System Installer: s=1 V i S Fc,:. r,,,l 114 K Registration #
Basement with plumbing: ❑ Garage ❑ !y9mmber of Bedrooms 3
Type of Water Supply: ❑ Community GYPublic ❑ Well Distance from well 100 k feet
System Type: 25 - Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
11113 ,pmni iid urvi mmmu in compnana wins appncaoie north uronna beneral
for Swap Treatment and Disposal, and all
Permit and construction Authorization.
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I. Performance:
System shall perform in accordance with Rule .1961.
II. Monitoring:
As required by Rule .1961.
111. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 0--
If yes, see attached sheet for additional operation conditions, maintenance and
reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sewaggjj..disposal system on the above captioned property.
Type of system: ❑
Conventional 701her i�'`u A -A, 4,c^ C6,a -n Ley-
Septic Tank:
lam' gallons Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditches Z" of each ditch t Z O feet
ditches
3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date03/zv//