OP RHTE#09-6--tgJ-0k Harnett County Department of Public Health 21310
PERMIT # ads a~~ Operation Permit
New Installation 53" Septic Tank ❑ Repair e Nitrification Line ❑ Expansion
PROPERTY LO(ATION: S2 fS3~ c~.n~,c~nn )Cd.
Name: (owner) Mk-S,A4 SUBDIVISION LOT # -2- Y
System Installer: kz-tn L s_o~z sk-f Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms ~d
Type of Water Supply: ❑ Community v public ❑ Well Distance from well feet
System Type: 777 r- 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 Nork Carolina General Statutes, a e Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
Permit and Construction Authorization.
Following are the specifications for the sews disposal y stem on he above captioned property.
Type of system: ❑ Conventional Other j_ ~ L Q Septic Tank: 6"6cj gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 1Z of each ditch S0 feet ditches 3 _ feet ditches J~' ' 24 inrhrc
rent rain Required: Linear feet
Authorized State Agen Date
System shall perform in accordance with Rule .1961.
As required by Role .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reoortina-
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