OPHTE# Harnett County Department of Public Health 24942
PERMIT # a / 10—
Ne�l w Installation C� eptic Tank tL.YNHfication Line ❑ Repair ❑ Expansion
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Name: (owner) � can o SUBDIVISION Cc, M— A ,'G�e LOT #
System Installer mac- snn M ti-hl<i cJ. Registration # _ e
Basement with plumbing: ❑ Garage ❑ Number of Bedroo��
Type of Water Supply: ❑ Community ❑ PublicelCeYW I Distance from well —1 CK�4 feet
System Type: aS,o (/oa—,c c n 4, L, Ac1 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mustcontact Health Department 6 months prior to expiration for permit renewal.
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meadnenr and uspoea, and al conditions of me Improvement reemn and
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage dismal system on the above caaptione�d_ pro erty.
Type of system: ❑ Conventional Ca'�her ��—"—Septic Tank: /C?o1S gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feettdres— 3 feet ditches /L3 inches
French Drain Required: Linear feet
Authorized State Agents/ / Date
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