OP RHTE# d I—5``Harnett County Department of Public Health 24163
PERMIT At Operation Permit
New Installation eptic Tanktt�M rdlcatlon Line ❑ Repair ❑ Expansion
eS L')o macA PROPERTY LOCATION: f5S 50,totr 4-ee- Lo (okl 5 S2 / �
Name: (owner) K�a;Lk eoIIcLrr8 SUBDIVISION a tygrtcr" LOT # Qq
System Installer: L,c�cc j 5L kW.( X_ Registration #
Basement with plumbing: ❑ Garage ❑ Nufssba of Bedrooms J
Type of Water Supply: ❑ Community ❑ Well Distance from well feet
System Type: 96%o Types V and A Systems expire in S years.
(In accordance with Table V a) Owner t contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in <amoliante with aoDlicable North
Rules for Sewage Treatment and Disoosal, and all conditions of the
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Authorization.
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PERMIT CONDITIONS:
17 h'r V
^ate 1,
I. Performance:
System shall perform in accordance ith Rule .1961.
11. Monitoring:
As required by Rule .1961. K
111. Maintenance:
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No l.K
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 sewagedial system on the above captioned property.
Type of system: ❑
Conventional 5Y6ther iS -A GF o a
Septic Tank: I WO gallons
Pump Tank: gallons
Subsurface
No. of exact length
3
width of
depth of
Drainage Field
ditches of each ditchyC] feet
ditches 3 feet
ditches t a inches
French Drain Required: linear feet
Authorized State Agent ,/�%� Date aa/
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