OPHTE# O Harnett County Department of Public Health 21 3 5 6
PERMIT # Operation Permit
New Installation '2~ Septic Tank ❑ Repair X Nitrification Line ❑ Expansion
PROPERTY LOCATION: M ~s>
Name: (owner) C U m~3C-11 Lp,tyq 1~ 0~•~, SUBDIVISION p~ ey(3cu~ LOT # I d~
System Installer: `Tap 4&?-rwN Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: 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 tarolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
196'
Permit and Construction Authorization.
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I. 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 X
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 Rroperty.
Type of system: El Conventional Other C+ar,~z.. V~?v~ - Septic Tank: IOOG gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 feet ditches 2) feet ditches t$-3t7 inches
French Drain Required: c--, aet
Authorized State Agent s " Date 313111
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