OPHTE# 40- 5-2`~I63 Harnett County Department of Public Health
PERMIT Operation Permit 21 7 7 5
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NLPINE
Name: (owner) M1->Q Co ram Ca \jc.-'S t. o .s SUBDIVISION S u cnt ~ ~-t LOT # 90
System Installer: Q-`~s 5T CoL\cwtitavo Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community X. Public ❑ Well Distance from well fDO feet
System Type: 1 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 Larohna beneral )tatutes, Rules for )ewage Treatment and Uaposal, and all conditions or the
rermrt and Lonstrucnon Mmonzaaon.
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
H. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
IV. Operation:
V. Other:
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other C-.Z
Subsurface No. of exact length
Drainage Field ditches f each ditch feet
French Drain Reauired: ~fee
Alarm ❑ 14201-ine ❑ PWR Line
Septic Tank: 100 G gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches alt ^3 6 inches
Authorized State Agent Date s\ 0 0
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