OPHTE# 14 -5- Harnett County Department of Public Health 23158
PERMIT # ���°b � Operation Permit
New Installation XSeptic TankNitrification Line F-1 Repair ❑Expansion
PROPERTY LOCATION: W i-L-L toN G rzssJ--r E
Name: (owner) SUBDIVISION LOT #
System Installer: __7r__n tZaw r� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public Well Distance from well SQ5 feet
System Type: =a= try 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.
Ims 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
rcnrn, wnun,vns.
I. Performance:
II. Monitoring:
Ill. Maintenance:
IV. Operation:
V. Other.
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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 operati n conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage dispos system on the � En (16)A �'
cap1tio property.
Type of system: El Conventional Other I�,"g\ Cn(6 — Septic Tank: gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field — itc�esr_.�_ of each ditch 1503 feet ditches 3 feet ditches 1QL2A`_34
French Drain Reauired: ''°�� 11ift LfPPt
Authorized State Agent Date
PWR Line
gallons
inches