OPHTE# 0~ -5---tz3$S- Harnett County Department of Public Health 21 0 5 2
PERMIT # 27 Operation Permit
EZ/New Installation 5 Septic Tank ❑ Repair E Nitrification Line ❑ Exoansion
PROPERTY LKATION:_l.~r,, Zrc1) 4
Name: (owner) SUBDIVISION LOT # z
System Installer. Registration # 31,.
Basement with plumbing: ❑ Garage umber of Bedrooms 3
Type of Water Supply: ❑ Community I✓J Public ❑ Well Distance from well feet
System Type: At- G /7 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 0 er must contact Health Department 6 months prior to expiration for permit renewal.
Ihis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sew a Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. 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 ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew a disposal system on the above captioned property. a~+~
Type of system: ❑ Conventional Other s~ ZE Y L G Septic Tank: f D d b gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Ag j Z Z ~1~4
Date