OPHTE#o~-s-ati5o► Harnett County Department of Public Health 2 0 5 4 5
PERMIT # a~ 1 Operation Permit
New Installation '~4 Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: "T;N6~N Q9
Name: (owner) _'E) C,o No~.ES SUBDIVISION V*%,As Po~•vC LOT # l~~
System Installer: -~,o 5se^r.c- Ste,,, Registration #
Basement with plumbing: ❑ Garage '~Z Number of Bedrooms
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well tpo feet
System Type: ~a 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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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)4
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches '-I ` of each ditch a.~S feet
French Drain Required: near"
Septic Tank: I c506 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
Authorized State Agent 0 Date