OPHTE# \ 0- 5- ~►4Li Harnett County Department of Public Health 21 4 41
PERMIT # Operation Permit
New Installation 'X Septic Tank ❑ Repair 'X Nitrification Line ❑ Expansion
PROPERTY LOCATION: (~oNfls>os~A~L
Name: (owner R'Z'Cc Co SUBDIVISION LOT # 3 b
System Installer: N Eo Q-e3-~- N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well C b V 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.
[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 ❑ NIX
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the ewage disposal system on the above captioned p erty.
Type of system: ❑ Conventional Other 9±4, , As ~2 CQ V 1 Septic Tank: IS)()() gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3.06 feet ditches 3 feet ditches a inches
French Drain Required , ~ltlrear feet
Authorized State Agent QL~-o Date 51I~