OPHTE#C9Harnett County Department of Public Health 2 0 8 2 4
PERMIT # a5l$3 Operation Permit
X New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Lr~.y~ QLc,c.1,
Name: (owner) ooCHoa ~AOr*,ES SUBDIVISION Hvoso g fi"c .mss LOT # 5
System Installer: ~~c~on E ~t Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 10o 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.
ims 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.
GO N V.
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O[DMIT f!1\Ir11T1AU[.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. 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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other 'Tian Co~,Ps Septic Tank: 100' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches a~ inches
French Drain Required: _ ParZ
Authorized State Agent Date `Z I ~~g 1,51
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Printed; 4/lid/2009 p 11t14:31AM
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161E McKay Town Rd ✓ Route: CHAD W
Cameron, HC28:126- Custai e-r: WNDERNS HACKHOE $F.KVIU
P'hanea (919) 49".30,11 f Date: 04/14/28f S •
Ct7iD Time put: L_._._ Timw Inc Cash$
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9L Name;, HEADERNIS VACKHOE SFMCE Trailer Inn
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Artisan : DEL, / Deliver Mips/Cull
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