OPHTE# a}Harnett County Department of Public Health
PERMIT # Operation Permit 21 9 9 7
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: r\,cxzZ t=O
Name: (owner) C-vM Lr-~c~9 ~+o SUBDIVISION ` rart~~~ L s>c LOT # r-X
System Installer: `N 9+aaw Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1®(3 feet
System Type: 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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rtKMI l l.unull IuNS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Required: c
Pump ❑ Alarm ❑ H120Line ❑ PWR Line
sewage disposal system on the above captioned pr°rty.
Other -tats ~Q v c,~ 1 Septic Tank: 100 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch t 6 feet ditches 4-' feet ditches inches
Authorized State Agent Date_