OPHTE# 0"1-5-'~ IL) Harnett County Department of Public Health 21 2 41
PERMIT # --)E5G30\ Operation Permit
X New Installation Nx~ Septic Tank E] RepairN Nitrification Line ❑ Expansion
PROPERTY LOCATION: '*1 L C.E
Name: (owner) Q.12~ ApmE5 SUBDIVISION kEN~AN Fp~ur.S LOT
System Installer: `4 Aye - o r14 * Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 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.
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: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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 captio ed property.
Type of system: ❑ Conventional ( Other CGaox.6EA LC",+vsc.~ F~ Septic Tank: ►bOO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches ~ of each ditch r- (D feet ditches 3 feet ditches .14 inches
French Drain Reauired:C-,- e, naa?~fanr
Authorized State Agent "'k, yw~~~~ Q"5 Date ~ I ~c~ t
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