OPHTE# o°►--a3 Harnett County Department of Public Health 21355
PERMIT # 'a`5~53 Operation Permit
New Installation X Septic Tank El RepairV Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~~+.►dEla-0
Name: (owner) C..vrr.ep~!~. c) AoctiES ~"e- SUBDIVISION _~F~2DL1~tt, aJ'35 LOT # `Oa
System Installer: s ~o aus,.,j" Registration #
Basement with plumbing: ❑ Garage( Number of Bedrooms -
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ICC) 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 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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DCQMIT rAlJn!TIAYC.
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 captione roperty.
Type of system: ❑ Conventional Other Cue rng ~Q tax Septic Tank: tbe50 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch a~0 feet ditches 3 feet ditches li inches
French Drain Required: ~4hwar faar
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Authorized State Agent 4 V-E'~s Date '3
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