OPHTE# C VW3LI Harnett County Department of Public Health 19611
PERMIT # Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) _ V P rrM REV t=Lc~rr~tirc SUBDIVISION _CAczn,, s sd A ( v- LOT #
System Installer. _en C- 5~2v Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Ic-~b feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
rots system has been mstalled in compkance with applicable North Carolina General Statutes, Ruks for Sewage Treatment and Disposal, and al car&om of the knprovement P"t and Constr don Audoization.
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1. Performance
II. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No X
If yes, see attached sheet for additional operation conditions, maintenance and reporting,
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: X Conventional ❑ Other Size of tank: Septic Tank: lcflb gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches ~ of each ditchfeet ditches feet ditches a4 _M inches
french Drain Required: _ n;. t
Authorized State Agent Date