OPHTE# M-S'- Zzs71/ Harnett County Department of Public Health 20883
PERMIT # Zs-gz 3 / Operation Permit
Cf New Installation L,J Septic Tank ❑ Repair 0 ""Nitrification Line ❑ Expansion
Name: (owner)
System Installer:
Basement with plumbing. ❑ Garage ❑ umber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well
System Type: C4~ 3
(In accordance with Table V a)
PROPERTY LOCATION/yL?,`(~,..,.~,.~
SUBDIVISION LOT # 3
Registration #
2
Distance from well feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas peen mnst'aueo in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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PERMIT CONDITIONS:
ta i-41MC. oy.xem snan PtNIU1111 III auuruance wlto nine lyol 11
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Following are the spe ' cations for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches Z of each ditch f feet
Septic Tank: D ID V gallons Pump Tank: gallons
width of depth of
ditches .3 feet ditches 2 inches
French Drain Required: Linear feet
Authorized State Age
11 Date `1 - Z 5 b~