OPHTE# I -SX2 13 Harnett County Department of Public Health 2 0 7 4 7
PERMIT #a Operation Permit
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C6?- New Installation cB-Septlc Tank ❑ Repair6Z Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) cSS SUBDIVISION LOT #
System Installer. C C a- Registration #
Basement with plumbing: ❑ Garage ;K' Number of Bedrooms j?
Type of Water !tA ❑ Co mmunity Public ❑ Well Distance from well 03 feet
System Type: . c, 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.
ri 111141mr. 3ruem midn penorm in accoraance wan rule iyoi.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No 9 -
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. M k- 2A t C
Following are the specifications for the sewage disposals on the above captioned property.
Type of system: ❑ Conventional ej Other ~ - c K L{ Septic Tank: _ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of Q
Drainage Field ditches of each ditch J feet ditches _ feet ditches D~ inches
french Drain Required: Linear feet
Authorized State Agent Date D- t7
MIS 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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PERMIT CONDITIONS: ,A
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