OPHTE# 16 -5 - 011-74S Harnett County Department of Public Health 21 0 51
PERMIT # 2(206?) Operation Permit
New Installation Septic Tank El Repair L~1 Nitrification Line El Expansion
PROPERTY LOCATION:-,,p lyy8 jilt
Name: (owner) C6rti„~._t ea roc SUBDIVISION LOT # 39
System Installer: Registration #
Basement with plumbing: El Garageumber of Bedrooms .3
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: Z~94bv cnna~94- Z ,-lu 0 bz 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.
[[Its Systemmnas peen mstaneo in compliancewith applicable
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North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. 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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sews a disposal system on the above captioned-Proper
Type of system: ❑ Conventional Other Zjn/ i NCnN ~r sue,. 'I,- "`7 Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of p depth of
Drainage field ditches ._3 of each ditch feet ditches J feet ditches z~ inches
French Drain Required: _ Linear feet
Authorized State Ag t t! r~~R R rn*>
Date Z -/o