OPHTE# 1'3"5-30590 Harnett County Department of Public Health
PERMIT # OK—) 3J 0 ep ration Permit 22890
New Installation Septic Tank '�( Nitrificatiq Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5` _N"903_
Name: (owner) M i L ; a j 2,sG5 N c- SUBDIVISION 44�,,,QE LOT #
System Installer: > M L ® -J Registration #
Basement with plumbing: ❑ Garage XNumber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t CQ feet
System Type: 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.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noox
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other' '*j Septic Tank: o a gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch C� feet ditches 3 feet ditches inches
French Drain Reauired: \ i� et
fe
Authorized State Agent 1 1— 5 Date `81 aD,IZ
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noox
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other' '*j Septic Tank: o a gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch C� feet ditches 3 feet ditches inches
French Drain Reauired: \ i� et
fe
Authorized State Agent 1 1— 5 Date `81 aD,IZ
13- 5-3o,5,�(D