OPHTE# Harnett County Department of Public Health
PERMIT # 212 21
Operation Permit
A New Installation X Septic Tank ❑ Repair( Nitrification Line ❑ Ex ansio
Name: (owner) LL C-~PROPERTY LOCATION: P n
SUBDIVISION
System Installer: f _ . LOT # I-~
sN CL.;-. e t «g E
Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Type of Water Supply: _
❑ Community Public ❑ Well Distance well t c r..
System Type: -_feet
(In accordance with Table V a) Types V and VI Systems expire in 5 years.
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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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
Subsurface ~ Other
No. of Septic Tank: F r^ r•
Drainage field ditches , exact length gallons Pump Tank: gallons
of each ditch ~?C width of depth of
French Drain Required: feet ditches
` 'ne feet feet ditches inches
Authorized State Agent NNX``
Date -04 i L { n.