OPHTE#C?-s - 3,17q 8 Harnett County Department of Public Health 21 12 6
PERMIT # 14rjS-,7 Operation Permit
Cew Installation e-rmSeptlc Tank ❑ Repair P-- trifi cation line ❑ Expansion
PROPERTY LO(ATION:57 I/ y/
Name: (owner) 6 SUBDIVISION e.4,n r A,,-t,f- LOT # / - 7
System Installer: S7~¢e~,c: t t,, s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms _ 7
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 777' 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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0 rC Z00y 41
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.1 -11.1vi.
1. Performance:
II. Monitoring.
111. Maintenance:
IV. Operation:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. e cta
Following are the specifications for the sewa disposal stem on the above captioned property.
Type of system: ❑ Conventional Other --f Z rle- J Septic Tank: (100 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized Sta]Age
Date 2~'%
~ _5' a,I~g8