OPHTE# I Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 2 3 2
:t~ New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L-. > 15.
Name: (owner) SUBDIVISION ag-0-4C LOT # O
System Installer: ~c)c~cac,.,, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1Q 0 feet
System Type: 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.
This 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
YtKMI I IUNUIIIUNS:
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
IV. Operation:
V. Other:
If yes, see attached sheet for additional operati n conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 36 Other E -Z Septic Tank: L000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditcTies ~.~of each ditch Wi d feet ditches feet ditches inches
French Drain Reauired: ee
Authorized State Agent qy"5 Date t6 !
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