OPHTE# - - q Harnett County Department of Public Health 23078
PERMIT # a� Operation Permit /
El New Installation 1:1 Septic Tank Q'Itrification Line ❑ Repair xpansion
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PROPERTY LO(ATION: ��'g5' . 4 �a� - �A
Name: (owner) ;4 r N�Ft SUBDIVISION ej_'4n da LOT # Y
System Installer: (` r� 5frj ejr-cd, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community &;4ublic ❑ Well DistafnTTcef�rom well /00 feet
System Type: 1) 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
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
Permit and construction Authorization.
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.
[?"' r D -Box Cal/ Pump ❑ Alarm P""_ /0 /0' H2OLine ❑
PWR Line
Following are the specifications for the sewage disposal system on the above cap tio d property. �^
Type of system: El Conventional Other 4 G WM/ Septic Tank: gallons Pump Tank: 2-> gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1S.5 feet ditches feet ditches inches
French Drain Required: ---* linear feet
Authorized State Agent w e Date