OPHTE# tC7--~.s34 Harnett County Department of Public Health
PERMIT Operation Permit 21 8 8 8
X New Installation _X Septic Tank ~K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M ra2ys 'KS)
Name: (owner) I`'1 ac~_•~ MRc;,z- LLC- SUBDIVISION Q~,~E~c czt~ LOT # %A
System Installer: ~a rj Registration #
Basement with plumbing: ❑ Garage ` Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \-d0 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
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1. 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 ❑ NOA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the ab ve captio°°
~~d property.
Type of system:
❑ Conventional Other
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1 Septic Tank: 10(50 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches l
of each ditch 150
feet ditches feet ditches au-3 inches
French Drain Required: Linear feet
Authorized State Agent ets Date 8 ti___