OPHTE# 15-5=365'3 Harnett County Department of Public Health 24003
PERMIT # --C3i576 Operation Permit
New Installation �X Septic Tank K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION:I, YfQ45 ZD
Name: (owner) ri iC.ZR9<.L.. SUBDIVISION "— LOT #
System Installer. )EP Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: —�% r_ 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 Carolina General Statuus Rules kr Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constriction Authoritarian.
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I. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above caption property.
Type of system: ❑ Conventional X Other C.var-fqer—Z �%� Septic Tank: l0(5 0 gallons Pump Tank: gallons
Subsurface _H exact length width of depth of
Drainage Field ditches of each ditch a 117 U feet ditches � feet ditches ! 1� -a inches
French Drain Retained: \ e�
Authorized State Aeent `�\\i 94-11) Date
15-5-374,53