OPHTE# cFi o Harnett County Department of Public Health 21 0 81
PERMIT Operation Permit
l New Installation ~ Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Noas6ct
Name: (owner) CP-ft a L rh two Er . SUBDIVISION \A o,5 ~¢E LOT # )i S
System Installer: O G GP gvv' a Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms L"
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well %0Ca 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 Deen mstatsea in compuance with apphcabie North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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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.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z '~7L ow Septic Tank: 1 d ~0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches` ~L-k_ of each ditch feet ditches 3 feet ditches inches
French Drain Required: _ ~inaar feet
Authorized State Agent Date t 01 010
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