OPHTE#COqHarnett County Department of Public Health 2 0 8 4 4
PERMIT # Operation Permit
New Installation '1!~ Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
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PROPERTY LOCATION: QoNoE sa Z.
Name: (owner) Cyr1BE,,:L,,-er sio ~~(3cnFS SUBDIVISION CAQ.otrs,►4,-, Seas LOT # 75
System Installer. TEti ~ r+ Registration #
Basement with plumbing: ❑ Garage )e Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ► c5o 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.
ims system nas peen mstanea in
with applicable north larobna beneral Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
111. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ Nom 1
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other. t~~HE~ CvNNEs ~t OECt JN\r~ OF L. NE 9 Sra+1l4 ,QE
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other Uj v Ic-'c.4 CARP- -R Septic Tank: 1-000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch ~O feet ditches -3 feet ditrhec 34 inrhac
French Drain Required: >n feet
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