OPNTE# 11-5-4'?3;?1 Harnett County Department of Public Health 24934
PERMIT # Q9 2d4 Owation Perl
New Installation Septic TankNitL-1"ririwtion Line ❑ Repair ❑ Expansion
PROPERTY LO[ATION: q$ dcrakC r ,�, c£ . Lo L\ Cs-:- czh. 5a 16ii o
Name: (owner) LxAcn to C .Y-jsk g NS , c1 C. SUBDIVISION i lye , C'C-, t' VC LOT # l 4
System Installer: K-Lksjs Registration #
Basement with plumbing: ❑ Garage E;--u—m�Bedrooms:
Type of Water Supply: ❑ Community Ld-Public ❑ Well Distance firism well ti't: feet
System Type: 'a5c/n tin Xs. -i k s:(Nr\ S 6c M ) 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.
This system has been installed in mmDliance with
PERMIT CONDITION!
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
and all conditions of the Improvement Permit and Construttion Authorization.
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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 ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewage jI system on the above captioned prope .
Type of system: ❑ Conventional then r:;�A
trench Drain Required: Linear feet
Authorized State Agent Date D 3�o7cy' 201 _
C jJor•n_� 7
Septic Tank: IVCYz gallons Pump Tank: IL`cr> gallons
Subsurface
Drainage Field
No. of
ditches
exact length
of each ditch '60 feet
width of depth of
ditches 3 feet ditches inches
trench Drain Required: Linear feet
Authorized State Agent Date D 3�o7cy' 201 _
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