OP RHTE# o`~-s-~333 Harnett County Department of Public Health 21 4 2 3
PERMIT # c'~-5'yr,3 Operation Permit
New Installation Septic Tank El Repair Nitrification Line El Expansion
PROPERTY LOCATION: ~A"L 1-ucta3
Name: (owner) Q~-L CLPC2~\}oK,f=s SUBDIVISION __~cYCO~,,.rA Qt,-F., LOT # 5o
System Installer: IJ " "E -:~So Ne~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well to o feet
System Type: ti 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.
Ihts 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 rMI11TU11dC•
1. 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 ❑ NoX
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 roperty.
Type of system: ❑ Conventional Other e-µNt-el;Q 1 Septic Tank: 1460 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch tan feet ditches feet ditches inches
French Drain Required:
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Authorized State Agent ~--IZZ4 ' )-,6 Date "}~~`l~1 b