OPHTE# s-NaugI Harnett County Department of Public Health 24923
PERMIT # a beration Permlt -
New Installation Erleptic Tanki� Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:— `b43ie �c �-
Name: (owner)� cco ,a- 1 SUBDIVISION LOT # 3
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Nur of Bedrooms
Type of Water Supply: ❑ Community f" Public ❑ Well Distance from well 00 feet
System Type: s> a.L—_.. �; _ 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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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:
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage dispoW system on the above captionen perry.
Type of system: ❑ Conventional ter �� eloL.� ..\1r1, --`t Septic Tank gallons Pump Tank: gallons
Subsurface No. of �.j— exact length width of depth of
Drainage Field ditches ` of each ditch feet ditches feet ditches I inches
French Drain Required: Linear feet
Authorized State Agent /AL�/Y6f�� Date JOE, l�ol�
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