OPHTE# C>'1-5 - R~o t Harnett County Department of Public Health 19938
PERMIT # 143.°1 Operation Permit
New Installation X Septic Tank ❑ Repair, Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) _Qav. Cozy VkoMe,:~ SUBDIVISION ~Je+t s-pc~p QoooS LOT # I_
System Installer. C ac.o--,. r-, CO-sTC",cr w hs Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community I Public ❑ Well Distance from well ►oo feet
System Type: a - Types V and VI Systems expire in 5 years.
(In accordance with Table Y a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims swstem nas Deco MUM M
win apphapR norm tarowna 4enral Natures, Auks tw kwage Treaaaent and Disposal, ad all conditioro of the Improvement Permit and Constncrion Audtonzation.
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I. 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 a tinned property.
Type of system: ❑ Conventional Other ea~ysTi+aF~6 AGGQewwG~t Size of tank: Septic Tank: L000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ► of each ditch S feet ditches 3 feet ditches R inches
french Drain Required: linear feet
Authorized State Agent ( ~a «v Cn o~+;scb~Itl Date 31 ~-j 68