OPHTE# /'1-,5=.33.3 Y3 Harnett County Department of Public Health 23426
PERMIT # c2-76'10 Operation Permit
P New Installation V Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION: d3c,..r. �C; J,..led-
Name: (owner)', (� % ��. �%: ��� ,t%�r ; f SUBDIVISION LOT #
System Installer: u( d Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: i of 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.
Ins 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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rtKMII LUNUnIUNN:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewwaa disposal system on the above captioned property.
Type of system: ❑ Conventional Iri Other Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches of each ditch X00 feet ditches 3
French Drain Required: Linear feet
1-12O1-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches 18- 2V inches
Authorized State Age pt' c> 3a:. ,4e li ___ Date /// �la�/
14 -S'- 33387