OPHTE# Harnett County Department of Public Health 21324
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LKATION: f`1-~ . Qwsceo,~~ Ctiua c~
Name: (owner) 9,-x;zov.t t,r SUBDIVISION DO"" rN Ro E LOT # 3
System Installer: C)d,., C,9.~ o-1 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: ~1T 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 peen mstaoea in
with applicable North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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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..vem on the above captioned property.
Type of system: ❑ Conventional Other 11 1 N0-6' C~" ~ eSeptic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc 3 of each ditch 11~30 feet ditches 3 feet ditches 30 inches
French Drain Required: n "'tiaear feet
Authorized State Agent ey"5 Date