OPHTE# Harnett County Department of Public Health 21 4 8 9
PERMIT # Operation Permit
New Installation 'R Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) )i-lc,v,, 6LL C.ow9%cr-O SUBDIVISION LOT # 13
System Installer: QTc S-c2,~ c,•c~„~ t) Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l Oa 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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PERMIT rANI)ITIr1N1-
I. 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 El 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 system on the above captioned property.
Type of system: ❑ Conventional X Other EZ Septic Tank: X000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch --75 feet ditches 3 feet ditches inches
French Drain Reuuired: ' A';n' nnf
Authorized State Agent_ A~~ iiZ-&)-'s Date E
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