OPHTE# �� -� -����< Harnett County Department of Public Health 23143
PERMIT # 9`2 C-3 Operation Perm*
New Installation Septic Tank nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ��sf
Name: (owner) ��au� ���. -ref SUBDIVISION _ 7-;,,y LOT # 17
System Installer: 0 f i "-f-'A Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -1/
Type of Water Supply: ❑ Community 9"'Public ❑ Well Distance from well feet
System Type: Il�"G 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:
Performance: System shall perform in accordance with Rule .1961.
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:
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
Type
the seewwa�tsposal system on the above captioned property.
62-
of system:
El Conventional
L�f" Other >c/ w Septic Tank: /0(30
gallons Pump Tank: gallons
Subsurface
No. of
f exact length width of
depth of
Drainage Field
ditches
of each ditch —30O _ feet ditches -7
/�
foot 161 er /X " ?n : -_L__
French rain Required: Linear feet
Authorized State :Agen e �J Date 12 --1
1,� -5 ^-3 � �� 1