OP RI'f_5-yoa402
HTE# (1-5 44412 Harnett County Department of Public Health 24702
PERMIT # Z q lqa, Operation Peowtt
C�New Installation Septic Tank Lel Nitrification Line ❑ Repair ❑ Expansion
b ,�A� CA r:sse a ssar PROPERTY LOCATION: 4/9'd 20/%nS m,// 2cs, (—sez*611
Name: (owner) C a<Ic�a ne. (on�raLk: = SUBDIVISION LOT #
System Installer. Graf_ k�C,0,,5 Registration #
Basement with plumbing: ❑ Garage E9-1(umber of Bedrooms Ni3a ('PA
Type of Water Supply: ❑ Community C4 -Public ❑ Well Distance from well /"%4 feet t<xis sloos<
System Type:Sss._/"�b 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.
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moan Lamina uenerm xamm, nota tot xrnee treatment and
the Improvement Pemut and Construction Authorization.
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1. Performance: System shall perform in accordance with Rule .1961. eaotc<Trr;
Il. Monitoring. As required by Rule .1961.
111. 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 ❑ H2OLine
❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioneogerty.
Type of system:
El
C7-Tther : -6 4-o 1� b
Septic Tank: /,3 C,,(—'> gallons
Pump Tank: /,R Cr gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch % S O feet
ditches 2_ feet
ditches i `i`3—Z a inches
French Drain Required: Linear feet
Authorized State Agent Date 10 ri cb
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