OPHTE# �ro'S'3`�76i Harnett County Department of Public Health 24469
PERMIT # �� � Operation Permit
New Installation )�j Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: tnsSflL V)-rm%%N Q -p
Name: (owner) WFC -40L �1cntc<-_51Nc. SUBDIVISION Pa'rtnPN CQD3s\mr— LOT # 13
System Installer: Registration #
Basement with plumbing: ❑ Garage F Number of Bedrooms
Type of Water Supply: ❑ Commgel IR Public ❑ Well Distance from well feet
System Type: _ y , x.A 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.
oris 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 Authoriation
rcnnu Lirnunlvm:
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 ❑ N
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other.
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maintenance and reporting.
❑ D -Box
❑ Pump ❑
Alorm ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
X Other SL
Septic Tank: 1(500 gallons
Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field Itct
4 of each ditch S feet
ditches 3 feet
ditches ��_ inches
French Drain Required:
Linear feet
Authorized State Agent Date