OPHTE#_ C n --S•-} Harnett County Department of Public Health 21 3 4 0
PERMIT Operation Permit
New Installation Septic Tank El Repair j Nitrification Line El Expansion
PROPERTY LOCATION: Pa~vas✓czos 1rl a,~t
Name: (owner) ~~5ou ~n•c.c_ SUBDIVISION CA~~~N~. Sc.e,sous LOT
System Installer: $a-ow N Registration #
Basement with plumbing: ❑ Garage ,K Number of Bedrooms 3
Type of Water Supply: ❑ Community A Public ❑ Well Distance from well 101 feet
System Type: ---ar 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 peen mstauea 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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FEW111 WRL)MV1113.
1. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned roperty.
Type of system: ❑ Conventional Other Gaar,g (&Z Septic Tank: t60O gallons Pump Tank: gallons
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch I ~.O feet ditches feet ditches ! e-~ inches
French Drain Required: - _ Lin
Authorized State Agent N g4m_5 Date 31YV I) 0