OPHTE#~Q -says Harnett County Department of Pic Health-
PERMIT # Operation Permit 21 5 4 4
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: n~ty "I .L Co
Name: (owner) C..V me;bta.+~•~c> \~.omyc5 SUBDIVISION `/aa.Ks-"Nq_r VLPssy;c~soty LOT # V ~
System Installer Qcw-tA Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well X44 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.
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.
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1. 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 ❑ NoA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned p erty.
Type of system: El Conventional Other Vii `
; 4 C1 ~ V t C Septic Tank: 160 gallons Pump Tank: T gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch _0 feet ditches 3 feet ditches XLA-38 inches
French Drain/eauired: , I inaar Y.ar
Authorized State Agent -1111, Date