OPHTE# 00)i X66 Harnett County Department of Public Health 21 0 7 6
PERMIT # Operation Permit
New Installation tg\ Septic Tank ❑ Repair LX Nitrification Le ❑ Expansion
PROPERTY LOCATION: -O Klaocac VZ QCxj u -ML) Cu-q E
Name: (owner) C ww5,co )-svL ` Hs:&A4 SUBDIVISION LOT #
System Installer: Go 'C eLE Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well Up4 feet
System Type: ']"L 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.
Ims system nas Deen mstauea in
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.
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. 'rANr~ C .N\F C.XeD ON ~0 1 cs t 47 as ce
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Following are the ssppeeo ications for the sewage disposal system on the above captioned property.
Type of system: Lif Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch feet
French Drain Reouired: n~ 'npk,lpAt
Authorized State Agent -,5
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Septic Tank: 004 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 18 `.2 inches
Date ya.13110 ~
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