OPHTE# OG1_ 5~1 Harnett County Department of Public Health 21258
PERMIT # Operation Permit
New Installation ~K Septic Tank ❑ Repair)< Nitrification Line ❑ Expansion
PROPERTY LO(ATION: 1 ~N Gr-"
Name: (owner) SUBDIVISION P rAS
LOT # T?
System Installer: Lt!2y S~P<etr Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: 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
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Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
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 X Other 1_~CL.E Cw\P_!~ Septic Tank: ~o<zic> gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -75 feet ditches 3 feet ditches Q4- 3 c7, inches
French Drain Required: I inuar fast
Authorized State Agent a.~H'n Date 2)i8
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