OPHTE#_ IQ- 5-a~5ay Harnett County Department of Public Health 21364
PERMIT #s$6v Operation Permit
New Installation K Septic Tank ❑ Repair- Nitrification Line ❑ Expansion
PROPERTY LOfATION: LP,5k %EQ,
Name: (owner) 4A y c7v-;i Svcz,LZ5 ~bj .5 SUBDIVISION E LOT # a~
System Installer: ~.oc eo c.x, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well )OG 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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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 operation conditions, 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 Other EZ FLo..j Septic Tank: l c~7 aG gallons Pump Tank: gallons
Subsurface loo of exact length width of depth of
Drainage Field ditches` of each ditch feet ditches 3 feet ditches a inches
French Drain Reouired: eo«
Authorized State Agent Date 4~L~So