OPHTE# OFt-5-a1-,» Harnett County Department of Public Health 2 0 7 7 2
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: V-p
Name: (owner) W N Co " n2Aj csCto w SUBDIVISION t 1 n cz-,j PL Kc.r-- LOT # 53
System Installer: S^r(L.cx-x-NN9 Registration #
Basement with plumbing: ❑ Garage ~k Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well \0Q) feet
System Type: -7:~ 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.
[his 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:
II. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Sc.Z ~r 'low Septic Tank: t oo O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc e _ _ of each ditch `7 b feet ditches feet ditches NS -=30 inches
French Drain Required:,` I% w feet
Authorized State Agent Date 51 A ~O°