OPHTE# %5-5— 3C7A Harnett County Department of Public Health 23863
PERMIT # QCM) O Operation Permit
)1� New Installation 'X Septic Tank 1 ' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: F'wt.."t,,) to
Name: (owner) Maa% o Mor.TUPp,2 SUBDIVISION LOT # a
System Installer: "-cN,f- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community < Public ❑ Well Distance from well t06 feet
System Type: --U35 Types V and VI Systems expire in S 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 Genenl Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .196).
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ —D -Box 13Pump ❑ Alarm ❑ H2O1-ine ElPWR Line
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional >� Other Z 1;7,o% -,r Septic Tank: t000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field -I of each ditch -1 O feet ditches 3 feet ditches INinches
French Drain Required: 'ear feet
Authorized State Agent 94 r �Datet l
15.5-36-1-��
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