OPHTE# T1- 6-ya&3, Harnett County Department of Public Health 24974
PERMIT # 02C c67�t ration Permit—'�
New Installation Septic Tank ftriftcation Line ❑ Repair ❑ Expansion rt�
rlvd.k —raj I.t- PROPERTY LOCATION: Y4o tcroXmiiI Lei CL.ennre Sr L s2- J
Name: (owner) 'Ta i;"—� SUBDIVISION LOT #
System Installer. x=k 0 a —c Svr Registration #
Basement with plumbing: ❑ larage ❑ Nymbet of Bedrooms
Type of Water Supply: El Community Pub11c ❑ Well Distance from well C - feet
System Type: (6nU.r n i nr. L C c ., o \ J Lc 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:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordancehnw h 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 -Boz ❑ Pump ❑
Following are the specifi . s for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch ink feet
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Alarm ❑ H2O1-ine ❑ PWR Line
Septic Tank: i Clc )5L, gallons Pump Tank: gallons
width of depth of
ditches feet ditches 3�' 8• inches
French Drain Required: Linear feet
Authorized State Agent �� Date s 1 asla�r8
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