OPHTE# C)-~ - s-Harnett County Department of Public Health 21 4 2 8
PERMIT # 2)'S 0 eration Permit
New Installation Septic Tank El Repair [X Nitrification Line D Expansion
PROPERTY LOCATION: Ct_L. o \ `->(z N o C-
Name: (owner) Pb t C_t_.~r- \kotNG5 SUBDIVISION C-K10Lwj?' *c s LOT # S 1
System Installer: *,-1" Nc oNGS Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well TOO feet
System Type: --CS. )p 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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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: "5< Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditch of each ditch d feet
French Drain Required: ei -~--bar feet
Septic Tank: 1000 gallons Pump Tank: gallons
width of depth of
ditches feet ditches S G ` inches
Authorized State Agent ez-,~15 Date 41 ill 0
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