OPHTE# L'6 -S –4 3Aq 3 Harnett County Department of Public Health 24987
PERMIT # 9(2�8&6 eration Penn---
New Installation Septic Tank 2'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: G S 416--u G �)5 O -V N -i
Name: (owner) Sto-OL M5c;'n '(;x 1A5 SUBDIVISION 'Mt)c t\ t c ry s LOT # >I
System Installer: — k, c Registration #
Basement with plumbing ❑ GarageNumju of Bedrooms
Type of Water Supply: ❑ Community ublic ❑ Well Distance from well � AC feet
System Type: .Qe duc k;c�n Ss .—= Types V and VI Systems expire in S years.
(In accordance with Table V a) VOwne ust contact Health Department 6 months prior to expiration for permit renewal.
inn Spam nu D"n inaaneo In tomwmnte wnn aDDIH]Dle Mahn larmma Uenend Juinjus, eines tar lewa¢e IRatment and
and all conditions at the Improvement Peemlt and Lon mittlon Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961. j
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage d' system on the above captioned prope
Type of system: ElConventional ther [� T i c-) "Zi J Septic Tank: I Z.50 gallons Pump Tank: --- +✓� gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch kCDC� feet ditches'— feet ditches inches
French Drain Required: __. Linear feet
Authorized State Agent Date O
wUll
V)
1