OPHTE# I6 -S-3iC 0 Harnett County Department of Public Health 24284
PERMIT #I Ooeration Permit
X New Installation 7�k Septic Tank lir Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C) -,D OSLO.
Name: (owner) �sr-�tsaccya.6 \ tie- SSUsLD(@5 SUBDIVISION I,-tomps 1'11-"Oo LOT #
System Installer: Cni :�s 5-s`�cy,�K
xLAt� Registration #
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Number with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 7Ma 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.
This 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.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ RI
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 sewage disposal s stem on the above captioned property.
Type of system: El Conventional Other Ems- FL t7 n1 Septic Tank: 100 gallons Pump Tank: gallons
Subsurface No. of exact length width of 3 depth of
Drainage -Fie ditches of each ditch 90 feet ditches feet ditches �'3 4 inches
French Drain Required: Linear feet
Authorized State Acent ����� ¢tW Date 1