OPHTE#I 0- S- -X35'+5 Harnett County Department of Public Health 21 4 6 4
PERMIT # Operation Permit
New Installation '~PR Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: L"o,-wa(~D
Name: (owner) Moss "oML ~6u~LOE~ "I e_ SUBDIVISION ',,4N1-IJ Us Ga-OVS LOT # Ei
System Installer: Lo"P4 N E- Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~110 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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S PV F SO-60
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DCDMIT rAtlI11T1A 11C.
1. Performance:
II. Monitoring:
III. 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. P o cvfl - m o J E rJ Pctti o 2 1 o s ~+`T F ~r+ 1 e 15` v LLPcS S 0"'3
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other C ~'Lt W Septic Tank: 1 OpC~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ~ of each ditch X00 feet ditches 3 feet ditches S $ inches
French Drain Reauired_ \ 4iDOa?aor
Authorized State Agent K 4s Date 5
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