OPHTE# OCA x.155 } Harnett County Department of Public Health 2 0 8 4 8
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Por4VeCLC5t1. Q~
Name: (owner) C\jr- .r +y ~o~•,~s 1~~ SUBDIVISION Caaot_N,4v. Sao„ LOT #
System Installer. `'Tip ~~zoW Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community X~ Public ❑ Well Distance from well S Q0 feed
System Type: =1 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.
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1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 Qv 2 F G,-\v ,.,s t-a Septic Tank: t !nod gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 50
feet ditches 3 feet ditches aL1'3 G inches
French Drain Required: _
Authorized State Agent ~S Date
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