OP RNTE#-Q°)i -5-a3'j1240-, Harnett County Department of Public Health 21 3 b 5
PERMIT # ~5-~~►3 Operation Permit
I)< New Installation K Septic Tank D Repair Nitrification Line El Expansion
PROPERTY LOCATION:- ~czsr~ ca_y ~Ly
Name: (owner) CAyiNEss LP,r.,,o ErEt~2r<. SUBDIVISION ocr~5-t ~}p, S LOT # _)3
System Installer: hoc-oC--.(- G cL'; 'Q I , C, Registration #
Basement with plumbing. ❑ Garage X Number of Bedrooms 1+
Type of Water Supply: ❑ Community -LKi Public ❑ Well Distance from well 10 O 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.
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.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 captioned property.
Type of system: ❑ Conventional Other CZ S=,- %,v
Septic Tank: 1000 gallons Pump Tank gallons
Subsurface No. of exact length width of
Drainage Field ditches 3 depth of
of each ditch feet ditches feet ditches lies
French Drain Required: r~~. toc
Authorized State Agent ~t c~LS Date
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