OPHTE#-/s� - y ai C`-1 Harnett County Department of Public Health 24153
PERMIT# D�121%I Oust on Permit —
Q--Wew Installation ❑'Septic Tank EtfTrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION::0)i c-"ry—� -r" C Sa.. 4;!�
Name: (owner) 'MAAccVN6u�SbNona. LLQ SUBDIVISION LOT # 3
t
System Installer: C-\ � n-- '�c-� Registration #
Basement with plumbing: ❑ Garage 5-1u�mber of Bedrooms 4—
Type of Water Supply: ❑ Community El-Furli—c ❑ Well Distance from well ^ A feet
System Type: 955 L y) : a i 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.
Phis system has been installed in
beneml
5J64sot -s n5to B a 09[t5118
Pvme G A\c+crry e o 3/ L' r, ( t?j
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
mules mr sewage reatment no msfimi, ana an commons or me impmnmem reams nm �mnum,mo wmno,i.mio,,.
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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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLme ❑ PWR Line
Following are the specifications for the sewage .
osal system on the above captioned
roperty.
Type of system:
❑ Conventional 5K Other
Septic Tank: Yam gallons Pump Tank: 1 oiCIC> gallons
Subsurface
No. of
exact length
width of depth of
Drainage field
ditches
of each ditch \ VO
feet ditches 3 feet ditches —ate inches
French Drain Required: linear feet
Authorized State Agent C� �� —f —� Date C>310('Ila
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