OPHTE# iy -5-J3 Q Harnett County Department of Public Health 23235
PERMIT # `1J7 Operation Permit
1� New Installation L�Septic Tank Pf Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_ ,/?Gva l �• .�� /�,�.
Name: (owner) x M CG Q SUBDIVISION Z,„ ®f %n =i LOT # 9 -6
System Installer: 2& I P/' .fir Registration #
Basement with plumbing: El Garage El Number of Bedrooms Z
Type of Water Supply: ❑ Community ❑ Public ❑ell Distance from well /QS" 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.
Ihls 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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DCDMIT f!1 \i rliTlfl \if.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 the seewwage disposal system on the above captioned property.
Type of system: El ' Conventional I; Other L Z `(6I Septic Tank: /'4 G gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch G feet ditches 3 feet ditches / inches
French Drain Required: Linear feet
Authorized State Age � �� ,�N f Date C /171. i