OPHTE# /0-_~_" OVI Harnett County Department of Public Health
PERMIT # as-5 ~ Operation Per iitt 21 5 6 a
LEI New Installation Id Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATIO : ~ ~t-
Name: (owner) s < < d'~~ ~ ~1 SUBDIVISION 1,J LOT # /J- 7
System Installer _ Registration #
Basement with plumbing: ❑ Garage E Number of Bedrooms 3
Type of Water Supply: ❑ Community i~Public ❑ Well Distance from well feet
System Type: 0 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
as-7. ~e~a~~~.~.~ I
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rt.nrni wmurttvms:
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 ERI'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew dispo
sal system on the above captioned property.
Type of system:
❑ Conventional 16 Other
& 2.-/7/, ,.i
Septic Tank: e~ gallons Pump Tank gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch ~ feet
ditches 3 feet ditches ~70 inches
French Drain Required: Linear feet
Authorized State Agen Date
4 19