OPHTE# - 0) 1 Harnett County Department of Public Health 19903
PERMIT # Operation Permit
~!(ew Installation --9- Septic Tank ❑ Repair-U' Nitrification Line ❑ Expansion
PROPERTY LO(ATION: C 0-)
Name: (owner) ~~Mt S SUBDIVISION L ;:e- k v n\\c: LOT # _ 3`F
System Installer. 1 . 3~-j N Registration #
Basement with plumbing ❑ Garage Number of Bedrooms_
Type of Water ply: ❑ Community Public CY Well Distance from ll
System Type: . n ^ rt , L-.-, A „ t feet
q IJI k2 Types V and VI Systems expire in S years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
tlxS srsten hat been "&Aled in compliana with *jAc" North (arolina General Statutes, Mules fa kwAV Treatment and Disposal, and al conditiom of the Irn o went Permit and (onmudion Audiaintian.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operabonWnditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional bother c~', Size of tank: Septic Tank: ~3D gallons Pump Tank: 1
Subsurface No. of ~ gallons
exact length width of depth of
Drainage Field ditches of each ditch 5 feet ditches feet ditches_ inches
French Drain Required: n Linear feet
Authorized State Agent Q Date .,OZ - )6-