OPHTE# `a."~-3) Harnett County Department of Public Health
PERMIT # Operation Permit
New Installation 'X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) M ~kEE HoM LL-C-- SUBDIVISION LOT
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5
Type of Water Supply: ❑ Community "TK Public ❑ Well Distance from well 10 O feet
System Type: a 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.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No x
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. fI
Drainage field ditches l
French Drain Required:
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sewage disposal system on the above caption roperty.
Other 1~1A"e' CCU Septic Tank: Q~ Q gallons Pump Tank: gallons
exact length width of depth of
N_ of each ditch 3~.0 feet ditches feet ditches N0' inches
Authorized State Agent N_,~L_, '&fz.G\~5 Date