OPHTE# ~3as~ Harnett County Department of Public Health 21 3 8 9
PERMIT # 'L Operation Permit
r New Installation `-Septic Tank El Repair dZ, Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) U~ik~(f~~~\ ~~~cy SUBDIVISION _ Inc 4 LOT # t-5b
System Installer: Q=-T 2, t ('t Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supyyl . d Commu ity ~ Public ❑ Well Distance from well _20 feet
System Type: )-\)C- 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.
I. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal s em on the above captioned property.
Type of system: ❑ Conventional Other 2 ri1Jt✓ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ~3 feet ditches feet ditches 37'~:> inches
French Drain Required: r~ linear feet
Authorized State
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