OPHTE# 15-5-3-7111-3 Harnett County Department of Public Health 24113
PERMIT # a$c o3 Operation Permit
New Installation Se`pti� Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATIOAZ—YEQ. 'PIP
Name: (owner) S )Qr`as u0.@. 1Aomc a—S) , SUBDIVISION LOT # I
System Installer: C7 s 5 � S Registration #
Basement with plumbing: ❑ Garage ',X Number of Bedrooms Li
Type of Water Supply: ❑ Continuum Public ❑ Well Distance from well t00 feet
System Type: �1 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
this symm 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:
ID..7..,.,,.... t....._ s._n _.1___ ._ _____�___
Il. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
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 �syewjage dispos9al system on the above capti tied property.
Type of system: ❑ Conventional > l Other + V MP _s E1 s7W Septic Tank: 10 (�s G gallons Pump Tank: 106 d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch t a0 feet ditches 3 feet ditches 7a�tl_ inches
French Drain Required__ `\Linear feet
Authorized State Agent_��' �wY\�4i&-Ag Date _ 4 I a'T I I b
IS -S-3013