OPHTE# /6- - ~ We Harnett County Department of Public Health
PERMIT # ~L Operation Permit 21 5 4 8
New Installation Septic Tank El" Nitrification Line ❑ Repair ❑ Expansion
461 PROPERTY LOCATION: r )l,
Name: (owner) GQ.-r i`c ti a SUBDIVISION a,r LOT #
System Installer dt~ - Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community 0' Public ❑ Well Distance from well feet
System Type: 72T G- 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.
this system has been installed in compliance with applicable North (arolina 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 ❑ No 9
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 sew disposalte2 ~oy/n he above captioned property. Iwo
Type of system: ❑ Conventional Other LJ Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length -7 width of depth of
Drainage Field ditches ` of each ditch t 0 feet ditches feet ditches -J8 inches
French Drain Required: Linear feet
Authorized State Age2~ Date
/ 0 - -216