OPHTE# J5 352 7a Harnett County Department of Public Health 23597
PERMIT # Z / / Operation PermitC3 New Installation l/ Septic Tank CA Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: tct3-7 4�r4,-ce rum
Name: (owner) �u n� -.� f SUBDIVISION LOT #141
1
System Installer: J a Registration #
Basement with plumbing: ❑ Garage''mber of Bedrooms It
,fiType of Water Supply: ❑ Community LJ' Public ❑ Well Distance from well feet
System Type: 71-10 6 2-5-2 f?'94SV 710- 57- T,,, , R,er ,6 Types V and VI Systems expire in 5 years.
(In accordance with Table —Va) Owner_ must con act Health Department 6 months prior to expiration for permit renewal.
IMS system has been installed in compliance with applicable North Carolina General Status Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance:
If. 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 ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sdisposal system on the above captioned property.
Type of system: Elewa Conventional Other Septic Tank: / DEQ gallons Pump Tank: _ /000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch IGC' feet ditches 3 feet ditches Zt t inches
French Drain Required: Linear feet
Authorized State gent Date _ ('
15-5-35272 (1) 15-5-35272 (2) 15-5-35272 (3) 15-5-35272 (4)