OP RHTE# Harnett County Department of Public Health 19675
PERMIT # Operation Permit
New Installation i®- Septic Tank ❑ Repairr Nitrification Line ❑ Expansion
PROPERTY LOCATION: c (Z ors c
Name: (owner) 6A\ SUBDIVISION 2 k
LOT # 3 9
System Installer. J~c,, t , 11 Registration #
Basement with plumbing: ❑ Garage QI Number of Bedrooms
Type of Water Supply: ❑ Community ® Public ❑ Well Distance from well s✓ feet
System Type: _-Z^ V, ~11 t~,- Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Inn system has been mstaned m compliance with applicable North cafnhna General Statutes, Auks for Sewage Treatment A Disposal, and all conditiom of the ktprovement Permit and construction Audwrizatiom
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Dr DMIT rAUnff1t%Ur.
1. 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 ❑ No,l~r
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 Others Size of tank: Septic Tank: J gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3 J feet ditches _ 3 feet ditches (2- inches
french Drain Required: Linear feet
Authorized State Agent Date