OPHTE# /4-/- ,5-- 3Z-70z Harnett County Department of Public Health 23108
PERMIT # cZ."] % i o Operation Permit
New Installation 2'— Septic Tank l Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1 1 L„ cap �'c f•
Name: (owner) 4k 4- :.',— ����: SUBDIVISION LOT # (z 5—
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community E?"'—Public ❑ Well Distance from well feet
System Type: ZtZ" 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.
Ims 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 fNJn!Tinuc•
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: El Conventional [Other Ez f /- � Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch 3Qo feet ditches � feet ditches 79_ inches
French Drain Required: Linear feet
Authorized State Agen -I •,w. Ca . %�/f Date !/%(201
iV -t =7z 73,2-