OPHTE# 1 g- 5 -4/v53c� Harnett County Department of Public Health 24663
PERMIT # Z93oS Operation Permi _---
9-' ew Installation ETIeptic Tank C�Utrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /li.xr�cya, (rrohfns /tj• S!t- /(//V
Name: (owner) r.�.ecsCo Z U,. uoc ��r SUBDIVISION 7<e LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage E Hiner of Bedrooms _`3
Type of Water Supply: ❑ Community []! Public ❑ Well Distance from well feet
System Type: 2.59 k s o — Types V and VI Systems expire in S years.
(1n accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
[his system has been installed in mmplianae with applicable North Carolina General Sutures, Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Constriction Authonzation
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage syste n��a� c�ed ro e .
Type of system: ❑ Conventional Other C' Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch —7L feet ditches _ feet ditches arae inches
French Drain Required: Linear feet
Authorized State Agent ���j Date
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All
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