OP RRHTE# 01-s-~V-(L Harnett County Department of Public Health
21421
PERMIT # Operation Permit
X New Installation ~K Septic Tank ❑ Repair fX Nitrification Line ❑ Expansion
PROPERTY LOCATION: 5--
Name: (owner) S n.'-E5 SUBDIVISION W v~ G2evE LOT # a~
System Installer: Registration #
Basement with plumbing: ❑ Garage K Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well 1dC) feet
System Type: " l1 0. 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.
[his 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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1. Performance:
II. 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 ❑ Nox
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: ❑ Conventional Other E-2- ' ' - Septic Tank: t c5 0 0 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 90 feet ditches- feet ditches _
French Drain Reouired: a ' aat'ar
Authorized State
Date L' 13.4 I ~
gallons
a0 ' 3Z7 inches