OPHTE#-~ Harnett County Department of Public Health 21 13 4
PERMIT # 02~ ~~7 Operation Permit
Chew Installation e tic Tank ❑ Repair nitrification line ❑ Expansion
PROPERTY LOCATION: 02rf
Name: (owner) CQ,,,6c.3>.d 4 SUBDIVISION tlcs,~lei~ LOT # ~."r
System Installer: Tcij r -o Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms _3
Type of Water Supply: ❑ Community I!T Public ❑ Well Distance from well feet
System Type: Q 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.
Ines 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:
If. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
IV. Operation:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. -rl+l~ OK
Following are the specifications for the sewage disposal m on the above captioned 1perty.
Type of system: El Conventional ~ Other syste wcns~lL (Qv C,-- Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches- inches
French Drain Reauired: f IRfIAf fPPt
Authorized State Agent ` N rL~ts Date 4\
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