OPHTE# 3 1 Harnett County Department of Public Health
PERMIT # Operation Permit 2 211 8
New Installation X Septic Tank Nitrification Line 1:1 Repair ❑ Expansion
Name: (owner)
System Installer: `"r ~o rav,s rJ
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 'K Public ❑ Well
System Type: g
(In accordance with Table V a)
PROPERTY LOCATION:
SUBDIVISION 1) ~.a ~E,j ' L,e2r_Z LO
3 Registration #
Distance from well 1 O (Z> feet
Types V and VI Systems expire in 5 years.
Owner must contact Health Department 6 months prior to expiration for permit renewal.
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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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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 operatoo✓✓n c(
IV. Operation:
maintenance and reporting.
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ff a, tione roperty.
Type of system: ❑ Conventional X Other C.Ap-~_"2_ l S X~' Septic Tank: 10 °C~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 O feet ditches feet ditches inches
French Drain Required: _ feet.
Authorized State Agent t\ \ gr~~5 Date '91 S4 1