OPHTE# Q1 9Harnett County Department of Public Health 21 1 5 4
PERMIT # Operation Permit
New Installation C~Septic Tank ❑ Repair R" Nitrification Line ❑ Expansion
PROPERTY LOCATIONL /11 lzl k P~(.
Name: (owner) ~terc le SUBDIVISION 3 t fi LOT #
System Installer: ed Rrc w.~ Registration #
Basement with plumbing: ❑ Garage Cumber of Bedrooms 3
Type of Water Supply: ❑ Community ?"Public ❑ Well Distance from well feet
System Type: TT C-1 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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PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No Le'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sews disposal system on th above captione property.
Type of system: ❑ Conventional Other ~u cct Septic Tank: ~Q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch lao feet ditches --3 feet ditches zq- 3 to inches
French Drain Required: Linear feet
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