OPHTE# 0j-S-Zj6-7q Harnett County Department of Public Health 20681
PERMIT # -Ls'" qtf :7 Operation Permit
New Installation L Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~Ivrs~r~43
Name: (owner) SUBDIVISION Us re LOT # 1
System Installer: c~A4; s j4r;ck1 Registration #
Basement with plumbing: ❑ Garage [Number of Bedrooms y
Type of Water Supply: ❑ Community Ej,fublic ❑ Well Distance from well feet
System Type: Vz4 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.
inrs 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:
rerlormance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Gd'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the spec cations for the sewage disposal system on the above captioned property.
Type of system: IV Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch d~ feet
French Drain Required: Linear feet
Septic Tank: ~C130 gallons Pump Tank: gallons
width of depth of
ditches feet ditches a inches
[Authorized State Agen • Date oC1 ~~0~