OPHTE#)- Harnett County Department of Public Health 21 101
PERMIT # Operation Permit
New Installation '~N Se tic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:-
Name: (owner) t - c.~a LAr.,~ ~a SUBDIVISION Ros 'Q~~;r.o,ti LOT # I
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1.40 feet
System Type: IZlj 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.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: L X Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches ~ of each ditch 1?, b feet
French Drain Reauired- _ fppt
Septic Tank: I UOO gallons Pump Tank gallons
width of depth of
ditches - feet ditches a.il inches
Authorized State Agent \\tZxs `OLIVM-1OLY----JO 06-) Date t ► I1
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