OPNTE# � -s -4a9qc,, Harnett County ryryDepartment of Public Health 24924
PERMIT # ori Q I /V eration Permit
d New Installation Septic Tankitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3ZKd t)C- 66,�b
Name: (owner) Cocv — .c . SUBDIVISION LOT # 0
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Commum f� ❑ Well Distance from well feet
System Type: a� o Gd c h �c n 5 s•(s+ _ 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.
in mmgiance wim adUmacie moan tartan UMeral studies. Notes for leware Treatment and
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I. Performance: System shall perform in accordance with Rule .1961-
11. Monitoring: As required by Rule .1961.
III. 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.
conditions of the Improvement Permit and construction Authorization.
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L.3 IUGR 5-!k>�b: L�v:•�i-let- l iwC_
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage di system on the above captioned property.
Type of system:
El them rlbts�s�� Septic Tank ICXYs gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch (o C5 feet ditches 3 feet ditches inches
French Drain Required: Linear feet --
Authorized State Agent Date 0316rd awl&
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