OPHTE# b4. Harnett County Department of Public Health 2 0 8 4 7
PERMIT # Operation Permit
New Installation )4 Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: LEM u G.i_ 4>
Name: (owner) N-1; Co«+5--~ a.uc,-roQ.,5 SUBDIVISION ~roct.Eg~s Oac.S LOT # 4 16
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System Installer:
-5 S-7a\C.X.,Lraw Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t C0 feet
System Type: 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.
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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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
_V-►OUSE SIriL SUs~-< UP~~ ELtMt rA-re- IyEC.O OM1 yn"?
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch _ 5 feet
French Drain Reauired: a 4~? fP'v~'
Septic Tank: gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 0114 inches
Authorized State Agent `N-4 e'_ Date X71