OPHTE# Qr--?0kCb Harnett County Department of Public Health 20791
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PERMIT #-s~'►63 Operation Permit
❑ New Installation ~K Septic Tank X Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: C-,L S,zc.,"vcs
Name: (owner) ~ ~4 c csc SUBDIVISION mg '4 I LOT # lb
System Installer. ~Eruz~ M~pt.srs Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~-COa feet y
System Type:S b 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.
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DCDMIT i- LMITIAtfr.
wim apphcaoie north tarolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
I. Performance System shall perform in accordance with Rule .1961.
II. 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 Q) o rQ o-c 1L.,-4 q__ 07- o.n x .J AN~F A~-c 4 1t, 51-
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ~4 Other Quflf'l0 G,D,,.,gEn Septic Tank: 10DO gallons Pump Tank: IC)4Q gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch, feet ditches 3 feet ditches inches
French Drain ReauireL _ r
Authorized State Agent Date 211 vi~ 0i
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