OPHTE# o'~ --s-aQ9i9 d Harnett County Department of Public Health 21262
PERMIT Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: nZa-*-5
Name: (owner) C~t`.a~u A.117 tiomets \N 4 SUBDIVISION P~srF- &fz p LOT # S9
System Installer: ~F-p 6~ crow>J Registration #
Basement with plumbing: ❑ Garage N Number of Bedrooms
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well to 0 feet
System Type:L 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.
CC
~ ~Qntcr~ ~ `i
INC
i
HO
5~ X35
Y~-
E
t•1raY r-6"WG-G CrC
Ar111I1T r-InlTln~lr_
1 LIII III lVl\VIIIV I\J.
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ~k
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 captione roperty.
Type of system: ❑ Conventional Other ~+PMwi 2~Q~~t. Septic Tank: Vb00 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch feet ditrhnc foot ditch- /.u
French Drain Required: ear
Authorized State Agent V~5 Date a d