OPHTE#/S"-!;- -3tr3S6 Harnett County Department of Public Health 23816
PERMIT# MSG Operation Permit
13' New Installation C3"Septic Tank p' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION:9L/'//8 j7x:ur . Cta
Name: (owner)c.,z/f-- -ARG SUBDIVISION LOT # Z
System Installer: z Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community C"Public ❑ Well Distance from well feet
System Type:5 V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact H th Department 6 months prior to expiration for permit renewal.
d119 d1l WIJUJLJVIU 01 Ole mipm.
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I. 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 ❑ H2O1-ine
❑ PWR Line
Following are the
specifications for the
sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
13 OtherZ5% t 11_
Septic Tank: 1 Low gallons
Pump Tank. gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches N
of each ditch joiD feet
ditches 3 feet
ditches l'r inches
French Drain Required: Linear feet
Authorized State Date I t — 1C, t 5
15-5-36350 (1)
15-5-36350 (2)
15-5-36350 (3)
15-5-36350 (4)
15-5-36350 (5)
15-5-36350 (6)
15-5-36350 (7)
15-5-36350 (8)
15-5-36350 (9)
15-5-36350 (10)