OPHTE#'~' Harnett County Department of Public Health 21 3 3 2
PERMIT # a.S Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~-1 aov En ~D
Name: (owner) ~-IM wC. SUBDIVISION \A LL LOT # 51
System Installer: `T C' 43¢r w'4 Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community _P~, Public ❑ Well Distance from well 1ba 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 Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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RM1rnl t,UriuniONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the aJtove captioned erty.
Type of system: ❑ Conventional Other GtiPe~~ri Q u c Septic Tank: 1 0p0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field diCCher t _ of each ditch feet ditches 3 feet ditches inches
French Drain Required: t~~ C~ iaeardeet
Authorized State Agent y REDS Date .311 G1 10