OPHTE# O"1-5ra3~`s~ Harnett County Department of Public Health 21 3 2 3
PERMIT # a- Q)LA Operation Permit
New Installation X Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LKATION:_ PoHoeaoscN Qp
Name: (owner) SE.,F y l_u c.P.s SUBDIVISION C c+ 1,~aar S Ep..sows LOT # 3a,
System Installer: --l-sp lC6 "wsl Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 71~
Type of Water Supply: ❑ Community Public ❑ Well Distance from well LOO feet
System Type: -7V r t 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.
INS 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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occMIT rAkln!Tfnllt.
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 ❑ NOX
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 erty.
Type of system: ❑ Conventional ~ Other dmSEcz ~Qv ~c ~y~~ Septic Tank: f 00d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 15 b feet ditches 3 feet ditches a y inches
French Drain Required: LI r feet
Authorized State Agent \N~ P_~ Date 3) 5