OPHTE# )4?1( Harnett County Department of Public Health 24837
PERMIT # aG SGf� OnAratlnn PArmit
L-1' New Installation C -Septic Tank f Ni n kation Line ❑ Repair ❑ Expansion
PROPERTY LO[ATION: '3 �&7 Cys M',ll {La . (sci kq�q�
Name: (owner) SUBDIVISION LOT #
System Installer. (3s e 1 .. Registration #
Basement with plumbing: ❑ Garage !Tltur of Bedrooms $,(—.
Type of Water Supply: ❑ Community ❑Fublic ❑ Well Distance from well A feet
System Type: 0`26`0 e"c r Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner m contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in tmm.liana with an. i.hl. Nnwh r—lm Gmml sn,.o- e.J- 1— t....,.. T...e.... ,.a n:...._! -_, .n --- _. —
I. Performance:
--......— ............. r...... .... ......... o..v .v��,..vurvn 1wurvuuum..
c2S o M1E9ocTyaN
Il. Monitoring:
As required by Rule .1961.
'tr'nAt 2 A`1.E�{
As required by Rule .1961. Other:
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Subsurface system operator required? Yes ❑ No
Subsurface
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
PMCN' 3)
width of depth of �V
Drainage Field
ditches
of each ditch ! c—'-.73 feet
ditches 3 feet ditches
i- T -
1
I
C�
I. Performance:
System shall perform in accordance with Rule .1961.
Il. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other:
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Subsurface system operator required? Yes ❑ No
Subsurface
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
width of depth of �V
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the
specifications for
the sewage disposal system on the above captioned roperty.
Type of system:
❑ Conventional
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Septic Tank f a5b gallons Pump Tank
Subsurface
No. of
exact length �
3
width of depth of �V
Drainage Field
ditches
of each ditch ! c—'-.73 feet
ditches 3 feet ditches
French Drain Required: Linear feet
Authorized State Agent S Date a O L
PWR Line
gallons
inches
;Apr.
i"A"A
I
I
F,
7X
.-
oi
.3
I
I