OPHTE# C-33 Harnett County Department of Public Health 21377
PERMIT Operation Permit
(--New Installation C~L Septic Tank ❑ Repair V- Nitrification Line ❑ Expansion
PROPERTY LOCATION: C
Name: (owner) r 0 >~c SUBDIVISION li es~ o LOT #
System Installer: 2A 1D4-1% Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supp1 ❑ Community ublic ❑ Well Distance from well 100 _ feet
System Type: Pt~t / f Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
This 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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rcmni WRI0111Un3.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operatio nditions, maintenance and reporting.
IV. Operation:
V. Other. Pmw6n f `c~P;FP ~C t6q o.., 6 1~ T6
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Following are the specifications for the se ge disposal sy- o~gGthe above captioned property.
Type of system: ❑ Conventional `Other 'v')
Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ,,,,,f each ditch feet ditches feet ditches inches
French Drain Required: t
Authorized State Agent L Date cI1'A)to