OPHTE#„-5'~'(-k --0 Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 3 2 7
New Installation X Septic Tank' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Mc ep,N Q-Ar", L^ L_ C 1lcZe.
Name: (owner) ~SIM,4 C>,PWEL G.ij Ue A SUBDIVISION LOT #
System Installer: ~<-F4 NA0 L.;~..p.w0 Registration #
Basement with plumbing: ❑ Garage ❑ 55 ) c~ cc vpa~ra-s}
Type of Water Supply: ❑ Community "X Public ❑ Well Distance from well lC~ d feet
System Type: X \D 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 nas peen instanea in compuance w¢n appucame norm Lamina t,enerai statutes, Hies tor sewage treatment and tnsposai, and au conditions of the improvement rermtt and t.onstructmn Authorization.
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I' Mil CUNDIIIUNS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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 ❑
Following are the specifications for the sewage disposal system on the abpgve~~ccaptind property.
Type of system: ❑ Convua'onal Other CNAC~^r3Eri Q00 / Septic Tank: -1-900
Subsurface No. of exact length width of
Drainage Field ditches of each ditch :L00 feet ditches 3
French Drain Reauired:
H2OLine ❑
PWR Line
gallons Pump Tank: -3-Sroo gallons
depth of
feet ditches 1$ " inches
Authorized State Agent s , "W A ~E- Date 5