OPHTE# O'l ~x335fI Harnett County Department of Public Health 21 0 9 4
PERMIT # Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Pa~nFSZa~~, CD -
Name: (owner) 70sarv QQ..c.[- Ca r,SS . SUBDIVISION C.~oL r ntQ. 'I&SGotAS LOT # -1_
System Installer. Eo Irv Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: i;;Mt 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.
This 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:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Al
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional XI Other Qv v,,, --3. C->Aps>QEn Septic Tank: i o b o gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ► If each ditch 110 feet ditches 2~ feet ditches - a!j inches
French Drain Reauired: At
Authorized State Agent \ t£NN Date l►_1S►a
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