OPHTE#�E'`J3`6�119 Harnett County Department of Public Health 24438
PERMIT At %91 Operation Permit
K New Installation '5k Septic Tank '�< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: $v car la 6 Qz
Name: (owner) M<KE.& SUBDIVISION Q c,,, a N LOT # 1p4
System Installer. F -001C. Registration #
Basement with plumbing: ❑ Garage`R Number of Bedrooms_
Type of Water Supply: ❑ Community '� Public El Well Distance from well 10 C! feet
System Type:h Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in rompliance with applicable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conmuman Authorization.
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PERMIT CONDITIONS -
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
IV. Operation:
V. Other.
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned grope�}Y -
Typeofsystem• ❑ Conventional Other PJ.-��5� (_x-\t�rn6�nlf�y� Septic Tank: tgo0 gallons Pump Tank: tO6Cl gallons
Subsurface f exact length width of depth of
Drainage Field ditches of each ditch 300 feet ditches _ feet ditches 1$ 3a inches
French Drain Reglt inear feet
Authorized State Agent_ z��'�A �p. -5 Date
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