OPHTE# 11-5-4d ay9 Harnett County Department of Public Health 24980
PERMIT # J1,60eration Permit �
Ne -New Installation eptic Tank Ca'Nitrirication Line ❑ Repair ❑ ExpansiQi
PROPERTY LOCATION: obi �elnnnL ! (Docs R� ; L II1(c1
Name: (owner) Lc.rincc) C o*)rn giA5 [.LC_ SUBDIVISION C elon �1 N ((S LOT # 5?
System Installer. E1vsb Registration #
Basement with plumbing. ❑ Garage Ca-fumaer of Bedrooms .'_
Type of Water Supply: ❑ (am munity❑ Well Distance from well feet
System Type: `aZ S`'o (Te�S5 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner mu contact Health Department 6 months prior to expiration for permit renewal.
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PERMIT
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Muria taronna unread >[amles, holes For sewage Ireaunent and unposal, and all conditions of the Improvement Permit and Conswttion Authorumon.
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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.
IY. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage ' sal system on the above captioned roperty.
Type of system: ❑ Conventional GY Other ilii 61,yAA er Septic Tank: QDf.� gallons Pump Tank: gallons
Subsurface No. of exact length width of n depth of
Drainage Field ditches of each ditch :5 feet ditches J feet ditches Pc) inches
French Drain Required: Linear feet
Authorized State Agent 4� Date v6' /a2111 '-x�t6