OPHTE# o9-sa~o~o Harnett County Department of Public Health 21 3 3 0
PERMIT # Operation Permit
New Installation N Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: t~lvQse~zv Ps>
Name: (owner) CPS . N cs3 La~,a d~v SUBDIVISION ~oac < o, s LOT # V~S'
System Installer: G , C~ez Registration #
Basement with plumbing: ❑ Garage "X Number of Bedrooms 3
Type of Water Supply: ❑ Community ~4 Public ❑ Well Distance from well k0(7 feet
System Type: 2~5y 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.
lp
ts6' j ➢ ~
rl
A1TO D
i~nrni wnunWna.
1. Performance:
II. Monitoring:
III. 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~K
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 property.
Type of system: ❑ Conventional 'Fj~r Other ~fceE C~\P Septic Tank: 1400 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch 100 feet ditches 3 feet ditches IX -4 inches
French Drain Required: A Linear feet
Authorized State Agent aLay0 Date 711%