OPNTE#Harnett County Department of Public Health 21 17 0
PERMIT # Operation Permit
❑ New Installation ❑ Septic Tank ❑ Repair ❑ Nitrification Line ❑ Expansion
m--- PROPERTY LOCATION: Act~11( RD j
Name: (owner) h ~~1 ~ SUBDIVISION J:je,.~ f J LOT # 2
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Sup ❑ community t Public ❑ Well DistaJ~ce fro well feet
System Type: 1f\e(A "X~)VOI)t p A; CYl 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.
ims system nas+Deen msrauea in compliance wim applicable North tarohna 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: conventional ❑ Other Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: _ Linear feet
Authorized State Agent j . k,A' I ( c-"1 Date D2-